Malformações do desenvolvimento cortical: conceitos atuais e revisão de neuro-imagem avançada

Malformations of cortical development (MCD) result from disruptions in the complex process of the human brain cortex formation and are highly associated to severe epilepsy, neurodevelopmental delay and motor dysfunction. Nowadays, magnetic resonance imaging (MRI) is the cornerstone of the work-up of patients with epilepsy and modern advanced imaging techniques have improved not only our ability to detect and characterize cortical malformations, but also in identifying associated functional abnormalities that are far beyond the structural visualized lesions. Herein, we address the most currently used classifications of MCD and make a concise review of the embryological process of cortical development. Our main goal is to summarize recent advances and new trends in diagnostic imaging techniques concerning MCD. Thereafter, follows a brief discussion of specific disorders and their radiological features.As malformações do desenvolvimento cortical (MDC) resultam de distúrbios no complexo processo do desenvolvimento do córtex cerebral humano e estão comumente associadas a epilepsia severa e disfunções neuropsicomotoras. Atualmente, as imagens por ressonância magnética (RM) são a pedra angular no manejo de pacientes com epilepsia e modernas técnicas avançadas de imagem melhoraram não só a nossa capacidade de detectar e caracterizar as malformações corticais, mas também levaram ao reconhecimento de anomalias funcionais associadas que estão muito além das lesões estruturais visibilizadas. Abordaremos as classificações mais utilizadas de MDC e revisaremos a embriologia do desenvolvimento cortical. Nosso principal objetivo é destacar os avanços recentes e as novas tendências em técnicas de diagnóstico por imagens relacionadas às MDC. Em seguida, faremos uma breve discussão sobre alguns transtornos específicos e suas características radiológicas.FAPESPCNP

Magnetic resonance imaging findings of intracranial gossypiboma: a case report and literature review

Vários trabalhos têm descrito as características de gossipibomas por meio de radiografias convencionais e tomografia computadorizada, porém, seus achados na ressonância magnética são menos conhecidos. O objetivo deste estudo foi descrever as características de imagem de gossipibomas, ilustrando um caso de uma paciente com quadro clínico de febre e confusão mental com antecedente de cirurgia encefálica.Many reports in the literature have described findings of gossypibomas at conventional radiography and computed tomography. However, magnetic resonance imaging findings are still to be completely known. The purpose of the present study was to describe imaging findings of gossypibomas in a patient with previous history of brain surgery, presenting fever and mental confusion

Responsiveness of pituitary to galanin throughout the reproductive cycle of male European sea bass (Dicentrarchus labrax)

The neuropeptide galanin (Gal) is a putative factor regulating puberty onset and reproduction through its actions on the pituitary. The present study investigated the pituitary responsiveness to galanin and the patterns of galanin receptors (Galrs) expression throughout the reproductive cycle of two years old male European sea bass (Dicentrarchus labrax), an important aquaculture species. Quantitative analysis of pituitary and hypothalamus transcript expression of four galr subtypes revealed differential regulation according to the testicular developmental stage, with an overall decrease in expression from the immature stage to the mid-recrudescence stage. Incubation of pituitary cells with mammalian 1-29 Gal peptide induced significant changes in cAMP concentration, with sensitivities that varied according to the testicular development stages. Furthermore 1-29 Gal was able to stimulate both follicle stimulating hormone (Fsh) and luteinizing hormone (Lh) release from pituitary cell suspensions. The magnitude of the effects and effective concentrations varied according to reproductive stage, with generalized induction of Fsh and Lh release in animals sampled in January (full spermiation). The differential expression of galrs in pituitary and hypothalamus across the reproductive season, together with the differential effects of Gal on gonadotropins release in vitro strongly suggests the involvement of the galaninergic system in the regulation the hypothalamus-pituitary-gonad axis of male sea bass. This is to our knowledge the first clear evidence for the involvement of galanin in the regulation of reproduction in non-mammalian vertebrates. (C) 2017 Elsevier Inc. All rights reserved.European Union Seventh Framework Programme [262336]Spanish Ministry of Science and Innovation (MICINN)Spanish Ministry of the Economy and Competitiveness (MINECO) [AGL2009-11086]Spanish Ministry of the Economy and CompetitivenessRegional Government of Valencia [PROME-TEOH/2014/051]info:eu-repo/semantics/acceptedVersio

Phosphorus magnetic resonance spectroscopy in malformations of cortical development

INTRODUÇÃO: As malformações do desenvolvimento cortical (MDC) resultam de distúrbios no dinâmico processo de corticogênese cerebral e são importante causa de epilepsia grave, atraso do desenvolvimento, déficits motores e cognitivos. O papel do metabolismo na epilepsia humana tem sido extensamente debatido, e há inúmeras evidências que apontam para disfunções bioenergéticas como fatores-chave na ictogênese. Distúrbios metabólicos foram identificados nas malformações corticais com outras modalidades de neuroimagem, tais como a espectroscopia de prótons por ressonância magnética. Para o nosso conhecimento, entretanto, o metabolismo de fósforo em pacientes com epilepsia secundária a MDC não foi extensamente investigado até o momento. OBJETIVOS: O objetivo deste estudo foi avaliar o metabolismo de fosfolipídios in vivo em uma série de pacientes com epilepsia e MDC. MÉTODO: Trinta e sete pacientes com MDC e 31 voluntários foram estudados usando espectroscopia de fósforo por ressonância magnética (31P-ERM) tridimensional em aparelho de 3,0 Tesla. Os voxels nas lesões foram comparados ao córtex frontoparietal dos controles (volumes efetivos de 12,5 cm3). O parênquima aparentemente normal foi avaliado em voxels homólogos de pacientes e controles, abrangendo cinco regiões cerebrais: regiões nucleocapsulares direita e esquerda, córtex frontoparietal parassagital, e centros semiovais direito e esquerdo. Foram utilizados métodos de quantificação para ajustar os dados no domínio do tempo para as seguintes ressonâncias: fosfoetanolamina (PE), fosfocolina (PC), glicerofosfoetanolamina (GPE), glicerofosfocolina (GPC), fosfato inorgânico (Pi), fosfocreatina (PCr), e a-, b- e g-adenosina trifosfato (ATP). Também foram calculados o ATP total (ATPt=a-+b-+g-ATP), fosfodiésteres (PDE=GPC+GPE), fosfomonoésteres (PME=PE+PC), e as razões PME/PDE, PCr/ATPt, e PCr/Pi. O magnésio (Mg2+) e os níveis de pH foram calculados com base nos desvios químicos da PCr, Pi, e -ATP. RESULTADOS: Comparativamente aos controles, e assumindo um valor de p < 0,05 estatisticamente significativo, as lesões apresentaram redução dos valores de pH e aumento de Mg2+. Também foram encontrados redução significativa de GPC e PDE, e aumento da relação PME/PDE nas MDC. O parênquima aparentemente normal também demonstrou redução dos valores de pH no córtex frontoparietal e no centro semioval bilateral. As diferenças nos valores de pH, tanto nas lesões como no parênquima aparentemente normal, permaneceram estatisticamente significativas nos subgrupos individuais de MDC (displasia cortical ou hemimegalencefalia; heterotopia; polimicrogiria e/ou esquizencefalia). Não houve correlação entre o tempo da última convulsão e as alterações do pH. CONCLUSÕES: O Mg2+ e o pH são parâmetros muito importantes na regulação bioenergética e estão envolvidos em múltiplas vias da atividade elétrica cerebral. Nossos dados corroboram a ideia de que distúrbios metabólicos ocorrem nas lesões focais de MDC, com propagação para áreas remotas aparentemente normais. As anormalidades de GPC, PDE, e da razão PME/PDE sugerem que há deficiências na renovação das membranas celulares nas lesões dos pacientes com epilepsia e MDC.INTRODUCTION: Malformations of cortical development (MCD) result from disruptions in the dynamic process of cerebral corticogenesis and are important causes of severe epilepsy, neurodevelopmental delay, motor deficits and cognitive impairment. Metabolism in human epilepsy has been intensely debated, and there are several evidences pointing to brain bioenergetic disturbances as key factors in ictogenesis. Metabolic impairments in cortical malformations have been identified with other neuroimaging tools, such as proton magnetic resonance spectroscopy. To our knowledge, however, phosphorus metabolism in epilepsy caused by MCD has not been thoroughly investigated hitherto. OBJECTIVES: The aim of this study was to evaluate phospholipids metabolism in vivo in a series of patients with epilepsy and MCD. METHODS: Thirty-seven patients with MCD and 31 control subjects were studied using three-dimensional phosphorus magnetic resonance spectroscopy (31P-MRS) at a 3.0 T scanner. The voxels in the lesions were compared to the frontoparietal cortex of the control subjects (the effective volumes were 12.5 cm3). Normal appearing parenchyma was evaluated in homologous voxels of patients and controls encompassing five cerebral regions: right and left nucleocapsular regions, midline frontoparietal cortex and right and left semioval centers. Quantification methods were applied to fit the time-domain data to the following resonances: phosphoethanolamine (PE), phosphocholine (PC), glycerophosphoethanolamine (GPE), glycerophosphocholine (GPC), inorganic phosphate (Pi), phosphocreatine (PCr), and a-, b-, and g-adenosine triphosphate (ATP). We also estimated the total ATP (ATPt=a-+b-+g-ATP), phosphodiesters (PDE=GPC+ GPE), phosphomonoesters (PME=PE+PC), and the PME/PDE, PCr/ATPt, and PCr/Pi ratios. The magnesium (Mg2+) levels and pH were calculated based on PCr, Pi, and -ATP chemical shifts. RESULTS: Compared to controls and assuming that a p-value < 0.05 indicates significance, the MCD lesions exhibited lower pH values and higher Mg2+ levels. The lesions also presented significant reduction of GPC and PDE, and an increased PME/PDE ratio. The otherwise normal appearing parenchyma also demonstrated lower pH values in the frontoparietal cortex and bilateral centrum semiovale. The differences in pH values, both in the lesions and in the normal appearing parenchyma, remained statistically significant in individual subgroups of MCD (hemimegalencephaly or cortical dysplasia; heterotopia; polymicrogyria and/or schizencephaly). There was no correlation between the time of the last seizure and the pH abnormalities. CONCLUSIONS: Mg2+ and pH are very important in the regulation of bioenergetics and are involved in many electrical activity pathways in the brain. Our data support the idea that metabolic impairments occur in the lesions of MCD, with propagation to remote normal appearing parenchyma. The GPC, PDE, and PME/PDE abnormalities suggest that there are membrane turnover disturbances in MCD lesions

Phosphorus magnetic resonance spectroscopy in malformations of cortical development

Introduction Malformations of cortical development (MCD) result from disruptions in the dynamic process of cerebral corticogenesis and are important causes of epilepsy, motor deficits and cognitive impairment. Objectives The aim of this study was to evaluate phospholipids metabolism in vivo in a series of patients with epilepsy and MCD. Methods Thirty-seven patients with MCD and 31 control subjects were studied using three-dimensional phosphorus magnetic resonance spectroscopy (31P-MRS) at a 3.0 T scanner. Quantification methods were applied to the following resonances: phosphoethanolamine (PE), phosphocholine (PC), glycerophosphoethanolamine (GPE), glycerophosphocholine (GPC), inorganic phosphate (Pi), phosphocreatine (PCr), and a-, b-, and g-adenosine triphosphate (ATP). The magnesium (Mg2+) levels and pH were calculated based on PCr, Pi and b-ATP chemical shifts. Results Compared to controls, the MCD lesions exhibited lower pH values and higher Mg2+ levels (p<0.05). The lesions also presented significant reduction of GPC and PDE, and an increased PME/PDE ratio. The otherwise normal appearing parenchyma also demonstrated lower pH values in the frontoparietal cortex and bilateral centrum semiovale. Conclusions Our data support the idea that metabolic impairments occur in the lesions of MCD, with propagation to remote normal appearing parenchyma. The results also suggest that there are membrane turnover disturbances in MCD lesions

Current contribution of diffusion tensor imaging in the evaluation of diffuse axonal injury

ABSTRACT Traumatic brain injury (TBI) is the number one cause of death and morbidity among young adults. Moreover, survivors are frequently left with functional disabilities during the most productive years of their lives. One main aspect of TBI pathology is diffuse axonal injury, which is increasingly recognized due to its presence in 40% to 50% of all cases that require hospital admission. Diffuse axonal injury is defined as widespread axonal damage and is characterized by complete axotomy and secondary reactions due to overall axonopathy. These changes can be seen in neuroimaging studies as hemorrhagic focal areas and diffuse edema. However, the diffuse axonal injury findings are frequently under-recognized in conventional neuroimaging studies. In such scenarios, diffuse tensor imaging (DTI) plays an important role because it provides further information on white matter integrity that is not obtained with standard magnetic resonance imaging sequences. Extensive reviews concerning the physics of DTI and its use in the context of TBI patients have been published, but these issues are still hazy for many allied-health professionals. Herein, we aim to review the current contribution of diverse state-of-the-art DTI analytical methods to the understanding of diffuse axonal injury pathophysiology and prognosis, to serve as a quick reference for those interested in planning new studies and who are involved in the care of TBI victims. For this purpose, a comprehensive search in Pubmed was performed using the following keywords: “traumatic brain injury”, “diffuse axonal injury”, and “diffusion tensor imaging”

Toxic Leukoencephalopathies, Including Drug, Medication, Environmental, and Radiation-Induced Encephalopathic Syndromes

Toxic leukoencephalopathies can be secondary to the exposure to a wide variety of exogenous agents, including cranial irradiation, chemotherapy, antiepileptic agents, drugs of abuse, and environmental toxins. There is no typical clinical picture, and patients can present with a wide array of signs and symptoms. Involvement of white matter is a key finding in this scenario, although in some circumstances other high metabolic areas of the central nervous system can also be affected. Magnetic resonance (MR) imaging usually discloses bilateral and symmetric white matter areas of hyperintense signal on T2-weighted and fluid-attenuated inversion recovery images, and signs of restricted diffusion are associated in the acute stage. In most cases, the changes are reversible, especially with prompt recognition of the disease and discontinuation of the noxious agent. Either the MR or clinical features may be similar to several nontoxic entities, such as demyelinating diseases, leukodystrophies, hepatic encephalopathy, vascular disease, hypoxic-ischemic states, and others. A high index of suspicion should be maintained whenever a patient presents recent onset of neurologic deficit, searching the risk of exposure to a neurotoxic agent. Getting to know the most frequent MR appearances and mechanisms of action of causative agents may help to make an early diagnosis and begin therapy, improving outcome. In this review, some of the most important causes of leukoencephalopathies are presented; as well as other 2 related conditions: strokelike migraine attacks after radiation therapy syndrome and reversible splenial lesions. (C) 2014 Elsevier Inc. All rights reserved