Carotid intima-medial thickness measured on multiple ultrasound frames: evaluation of a DICOM-based software system

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Hypertensive posterior reversible encephalopathy syndrome causing posterior fossa edema and hydrocephalus.

Posterior reversible encephalopathy syndrome (PRES) is a well characterized entity resulting from the inability of cerebral autoregulation to adequately protect the brain from uncontrolled hypertension. It primarily affects the occipital lobes, but can also involve the structures in the posterior fossa including the brainstem and cerebellum. Treatment usually consists of strict blood pressure control, but more aggressive management may be indicated with acutely worsening neurological status. We present a patient with hypertensive encephalopathy that resulted in hydrocephalus and brainstem compression necessitating surgical decompression requiring ventriculostomy and suboccipital craniectomy. In rare cases, PRES can present with severe brainstem compression requiring emergent posterior fossa decompression. When brainstem signs are present on exam, emergent posterior fossa decompression may be safer than ventriculostomy alone

Hippocampal and Left Subcallosal Anterior Cingulate Atrophy in Psychotic Depression

<div><p>Background</p><p>Psychotic depression is arguably the most diagnostically stable subtype of major depressive disorder, and an attractive target of study in a famously heterogeneous mental illness. Previous imaging studies have identified abnormal volumes of the hippocampus, amygdala, and subcallosal region of the anterior cingulate cortex (scACC) in psychotic depression, though studies have not yet examined the role of family history of depression in these relationships.</p><p>Methods</p><p>20 participants with psychotic depression preparing to undergo electroconvulsive therapy and 20 healthy comparison participants (13 women and 7 men in each group) underwent structural brain imaging in a 1.5 T MRI scanner. 15 of the psychotic depression group had a first-degree relative with diagnosed affective disorders, while the healthy control group had no first-degree relatives with affective disorders. Depression severity was assessed with the Hamilton Depression Rating Scale and duration of illness was assessed in all patients. Automated neural nets were used to isolate the hippocampi and amygdalae in each scan, and an established manual method was used to parcellate the anterior cingulate cortex into dorsal, rostral, subcallosal, and subgenual regions. The volumes of these regions were compared between groups. Effects of laterality and family history of affective disorders were examined as well.</p><p>Results</p><p>Patients with psychotic depression had significantly smaller left scACC and bilateral hippocampal volumes, while no group differences in other anterior cingulate cortex subregions or amygdala volumes were present. Hippocampal atrophy was found in all patients with psychotic depression, but reduced left scACC volume was found only in the patients with a family history of depression.</p><p>Conclusions</p><p>Patients with psychotic depression showed significant reduction in hippocampal volume bilaterally, perhaps due to high cortisol states associated with this illness. Reduced left scACC volume may be a vulnerability factor related to family history of depression.</p></div

Parcellations of the anterior cingulate cortex.

<p>Dorsal anterior cingulate cortex (ACC) shown in blue, rostral ACC in red, subcallosal ACC in green, subgenual ACC in yellow. Figure reprinted with permission from John Wiley and Sons, from McCormick et al., (2008), license number 3103240766914.</p

Comparison of psychotic depression group with healthy controls on brain volumetrics.

<p>Comparison of psychotic depression group with healthy controls on brain volumetrics.</p

Laterality effects on hippocampus and subcallosal ACC volumes in psychotic depression compared to age-matched healthy comparisons.

<p>Laterality effects on hippocampus and subcallosal ACC volumes in psychotic depression compared to age-matched healthy comparisons.</p

Demographic Comparison between Psychotic Depression and Healthy Control groups.

<p>Demographic Comparison between Psychotic Depression and Healthy Control groups.</p