Seizures and Encephalitis in Myelin Oligodendrocyte Glycoprotein IgG Disease vs Aquaporin 4 IgG Disease

Importance: Antibodies to myelin oligodendrocyte glycoprotein IgG (MOG-IgG) are increasingly detected in patients with non–multiple sclerosis–related demyelination, some of whom manifest a neuromyelitis optica (NMO) phenotype. Cortical involvement, encephalopathy, and seizures are rare in aquaporin 4 antibody (AQP4-IgG)–related NMO in the white European population. However, the authors encountered several patients with seizures associated with MOG-IgG disease. Objective: To compare incidence of seizures and encephalitis-like presentation, or both between AQP4-IgG–positive and MOG-IgG–positive patients. Design, Setting, and Participants: Retrospective case series of all patients who were seropositive for MOG-IgG (n = 34) and the last 100 patients with AQP4-IgG disease (NMO spectrum disorder) seen in the NMO service between January 2013 and December 2016, and analysis was completed January 4, 2017. All patients were seen in a tertiary neurological center, The Walton Centre NHS Foundation Trust in Liverpool, England. Main Outcomes and Measures: The difference in seizure frequency between the AQP4-IgG–positive and MOG-IgG–positive patient groups was determined. Results: Thirty-four patients with MOG-IgG disease (20 female) with a median age at analysis of 30.5 years (interquartile range [IQR], 15-69 years), and 100 AQP4-IgG–positive patients (86 female) with a median age at analysis of 54 years (IQR, 12-91 years) were studied. Most patients were of white race. Five of the 34 patients with MOG-IgG (14.7%) had seizures compared with 1 patient with AQP4-IgG (2-sided P < .008, Fisher test). On magnetic resonance imaging, all 5 MOG-IgG–positive patients had inflammatory cortical brain lesions associated with the seizures. In 3 of the 5 MOG-IgG–positive patients, seizures occurred as part of the index event. Four of the 5 presented with encephalopathy and seizures, and disease relapsed in all 5 patients. Four of these patients were receiving immunosuppressant medication at last follow-up, and 3 continued to take antiepileptic medication. In contrast, the only AQP4-IgG–positive patient with seizures had a diagnosis of complex partial epilepsy preceding the onset of NMO by several years and experienced no encephalitic illness; her magnetic resonance imaging results demonstrated no cortical, subcortical, or basal ganglia involvement. Conclusions and Relevance: Patients with MOG-IgG–associated disease were more likely to have seizures and encephalitis-like presentation than patients with AQP4-IgG–associated disease

Machine learning as new approach for predicting of maxillary sinus volume, a sexual dimorphic study

The maxillary sinus is the most prominent in humans. Maxillary Sinus Volume (MSV) has grown in popularity as a tool to predict the success of various dental procedures and oral surgeries and determine a person's gender in cases such as forensic investigations when only partial skulls are available. Because it is an irregularly shaped cavity that may be difficult to measure manually, robust imaging techniques such as cone-beam computed tomography (CBCT) used in conjunction with machine learning (ML) algorithms may offer quick and vigorous ways to make accurate predictions using sinus data. In this retrospective study, we used data from 150 patients with normal maxillary sinuses to train and evaluate a Python ML algorithm for its ability to predict MSV from basic patient demographics (age, gender) and sinus length measurements in three directions (anteroposterior, mediolateral, and superoinferior). The model found sinus length measurements had significantly higher predictive values than either age or gender and could predict MSVs from these length measurements with almost linear accuracy indicated by R-squared values ranging from 0.97 to 0.98% for the right and left sinuses

How Different Preparation Techniques Affect MRI-Induced Anxiety of MRI Patients: A Preliminary Study

Background: Magnetic resonance imaging (MRI) exams may cause patients to feel anxious before or during the scan, which affects the scanning outcome and leads to motion artifacts. Adequate preparation can effectively alleviate patients’ anxiety before the scan. We aimed to assess the effect of different preparation methods on MRI-induced anxiety: We conducted a prospective randomized study on MRI patients between March and May 2022. We divided 30 patients into two groups: the control group, which received routine preparation (RP), and the experimental group, which received video preparation (VP).We used the State-Trait Anxiety Inventory (STAI) to measure anxiety levels before and after the interventions. We assessed patients’ self-satisfaction after the scan: After preparation, VP (STAI mean = 10.7500) and RP (STAI mean = 12.7857), we observed a significant association between the pre- and post-STAI results in VP (p = 0.025). The effects of both methods in decreasing anxiety were more significant for first-timers (p = 0.009 in RP/0.014 in VP). We noted high satisfaction levels for both forms of preparation. The VP technique was superior in reducing patient anxiety, especially in first-time MRI patients. Hence, VP techniques can be used in different clinical settings to reduce anxiety and facilitate patients’ understanding of the instructions given

A Multimodal MRI Study of the Human Brain Investigating Neuromyelitis Optica Spectrum Disorders

Study 1 A multicentre longitudinal MRI study of MOG-antibody associated central nervous system inflammation Introduction Myelin oligodendrocyte glycoprotein antibodies (MOG-ab) cause a primary demyelinating illness targeting oligodendrocytes. Some patients fulfil the diagnostic criteria of NMOSD according to the IPND 2015(1); however, there are differences (2-5). Here, we investigate the epidemiology clinical Spectrum and longitudinal MRI characteristics in MOG-ab demyelinating disease (MOGAD) in a multicenter cohort. Methodology 1.5 and 3T MRI scans of 56 MOG-antibody positive patients from the U.K. and India were retrospectively reviewed, and MOG-ab tested, using live CBA IgG1 secondary Ab. The brain, spinal cord, and optic nerve scans were assessed for previously reported NMOSD and MS related changes by three reviewers trained by the Neuroradiologist (MB) (AA, DW, SH). Then, all the results were reviewed by the Neuroradiologist (MB). Longitudinal MRI scans were reviewed for temporal changes. Results MRI brain scans showed lesions in 32% brain stem, hemispheric white matter lesion 29%, u-fibre 20%, Corticospinal tract lesion 21%, Periependymal 14%, Cortical, Temporal, and Cerebellar lesion in 13%. The spinal cord MRI scans showed that 69% have LETM. Optic nerve scans showed 33% had bilateral optic neuritis, 61% long segment lesions, and orbital/ canalicular lesions, 83%. Longitudinal results showed that asymptomatic patients (13, median follow-up 16.5 months) (69%) who were off treatment showed improvement, and 31% were unchanged. In the follow up Patients (29, median follow-up 14 months), 55% showed improvement regardless of treatment, 21% resolution of lesions, 17% unchanged, and only 7% showed progression. Conclusion MOG-ab associated central nervous system inflammation can be associated with a wide range of MRI appearances; however, none seem exclusive for it. In a third of the MRI scans reviewed, brain stem and hemispheric lesions were detected. There was no corpus callosum Dawson’s fingers lesions seen in this cohort, and the AQP4-NMOSD typical lesions were not uncommon. The MRI showed mostly long cervicothoracic myelitis in the spinal cord, and in the optic nerve, long anterior lesions were most common. Reviewing the longitudinal scans showed no lesion accruing overtime in asymptomatic patients, and a variable degree of atrophy was associated with the lesion resolution. Study 2 Multimodal MRI Study investigating AQP4-NMOSD and MOGAD brain differences Introduction Neuromyelitis Optica Spectrum Disorders (NMOSD) are rare, relapsing, inflammatory disorders of the central nervous system, mainly targeting the spinal cord and optic nerves (1, 11). Although less well studied, it is increasingly recognised that the brain is also commonly affected (12, 13). Antibodies to aquaporin-4 (AQP4-ab), and more recently, antibodies to myelin oligodendrocyte glycoprotein (MOG-ab) have been identified in the sera of individuals with NMOSD (2, 14-16). In our research, I aim to test the hypothesis that the inflammatory process in the brain is different between AQP4-ab positive NMOSD (AQP4-NMOSD) and MOG-ab positive (MOGAD) patients. Using conventional MRI scans limits the ability to detect brain microstructural changes. In this thesis, Diffusion tensor imaging - Tract based spatial statistics analysis (TBSS), Voxel based Morphometry (VBM), Freesurfer - are used to detect differences in the AQP4-NMOSD and MOGAD positive patients, and directly compare them to each other and healthy controls. Methodology 40 participants scanned (20 AQP4-NMOSD, 20 MOGAD). All participants were in remission for at least six-months. 32 healthy controls were also scanned for comparison. Brain MRIs were obtained for each participant using 3-T MRI. Automated Lesion Segmentation (LST) was used to extract and investigate lesion volume and count. White matter diffusion tracts were analysed using DTI metrics (Fractional Anisotropy (FA), Mean Diffusivity (MD), Radial Diffusivity (RD), and Axial Diffusivity(AD)) perceived from TBSS with free water correction to increase the analysis sensitivity. VBM and Freesurfer were used to investigate grey matter differences. Correlation with neurostatus scores and patients’ clinical demographics was also performed

Persistent Mullerian duct syndrome with polycystic ovary in a young adult: A rare case report

Persistent Mullerian Duct Syndrome (PMDS) is a type of pseudohermaphroditism that occurs in males. It is an autosomal recessive type of familial disease that is commonly associated with a history of consanguinity. We have documented this case of a 22-year-old adult male who came with acute right iliac pain; after an ultrasound scan and hormone investigations, he was diagnosed with polycystic ovarian syndrome (PCOS)