Magnetic resonance imaging findings within the posterior and lateral columns of the spinal cord extended from the medulla oblongata to the thoracic spine in a woman with subacute combined degeneration without hematologic disorders: a case report and review of the literature

<p>Abstract</p> <p>Introduction</p> <p>Subacute combined degeneration of the spinal cord is a rare cause of demyelination of the dorsal and lateral columns of the spinal cord and is a neurological complication of vitamin B₁₂deficiency. Subacute combined degeneration without anemia or macrocytosis is rare.</p> <p>Case presentation</p> <p>We present a case of cobalamin deficiency in a 29-year-old Moroccan woman who presented with subacute combined degeneration without evidence of anemia or macrocytosis. Magnetic resonance imaging of the spinal cord demonstrated abnormal hyperintense signal changes on T2-weighted imaging of the posterior and lateral columns from the medulla oblongata to the thoracic spine. A diagnosis of subacute combined degeneration of the spinal cord was considered and confirmed by low serum cobalamin. The patient was treated with vitamin B₁₂supplements and showed improvement in her clinical symptoms.</p> <p>Conclusion</p> <p>Physicians should diagnose subacute combined degeneration in patients early by having a high index of suspicion and using diagnostic tools such as magnetic resonance imaging.</p

Oral Presentations in Order of Conference Program. The role of personalised virtual reality in education for patients post stroke: A case series.

Introduction: Stroke education is essential to prevent future strokes andpromote maximum recovery, however, current techniques are limited andmany patients remain confused. This series of case studies investigates thebenefits of a personalized and novel education session using a threedimensional (3D) computer generated visualization of patient’s MRI andCT images to enhance their understanding of stroke.Methods: Patient 1, 69 yo male, 11.5 months post middle cerebral artery(MCA) infarct. Patient 2, 66 yo male with 4 year history of multipleischemic strokes in the MCA and medullary areas. Structured interviewswere delivered before and after the educational intervention. Interviewresponses, MRI angiography,CT DICOM datasets and gaming technologywere used to create a virtual tour of the patient’s vasculature from insidethe vessels. During the educational intervention the patients wore a headmounted display and were guided by a rehabilitation physician throughtheir personalized virtual simulation.Results: The structured interviews outlined a number of commonthemes; continued confusion in regards to risk factors, stroke causationand the effects of acute treatment; and the benefits of visualization tounderstand and promote recovery. The 3D visualization sessions were welltolerated with participants reporting high satisfaction, a new understandingand an enhanced motivation to improve and prevent future strokes.Conclusions: Preliminary results suggest a personalized and guided 3Dvisualization consultation is an effective educational tool. The following 3case studies will investigate the efficacy of delivering this form of educationalintervention to a heterogeneous cohort with a variety of strokepresentations

Stroke: Occlusion and Flow

Exhibition:Why are we both attracted and repulsed by Blood?During our curatorial journey, we quickly discovered that blood is polarising. While it is crucial to keeping us alive – filling seven percent of our body – blood still commonly makes us feel uncomfortable. It is this fascinating positive/negative dichotomy that is fundamental to the narrative we explored. Blood is a powerful cultural symbol of positive and negative associations, one that represents life and death, health and sickness, and attraction and repulsion.STROKE: OCCLUSION AND FLOWArtist John McGhee3D Virtual Reality Experience - Oculus Rift HeadsetThis series of virtual reality experiences focus on immersing the user in actual clinical stroke data. The imagery displayed on the Oculus Rift headset is a direct visualisation of 3D clinical Magnetic Resonance Imaging (MRI) and Computed Tomography CT data. The datasets were acquired from stroke survivors with a history of cardiovascular disease and high cholesterol. When wearing the headset, users are able to move along the arteries in the brain by means of a video game controller. They can follow the path of the red blood cells from the aorta to the site of the stroke. In this series, three of the most common types of stroke were visualised, including ischaemic strokes caused by vessel occlusion, thromboembolism, and a haemorrhagic stroke caused by aneurysm rupture.McGhee has created visual imagery drawn from the cinematic, directly influenced by the feature film ‘Fantastic Voyage’. The aesthetic experience uses 3D computer generated imagery (CGI) atmospherics and augmented components such as arterial plaque on the blood vessel walls and red blood cells. All of these visual features increase the feeling of embodiment

The current role of MRI in differentiating multiple sclerosis from its imaging mimics

MRI red flags proposed over a decade ago by the European Magnetic Resonance Network in MS (MAGNIMS) have guided clinicians in the diagnosis of multiple sclerosis (MS). However, the past 10 years have seen increased recognition that vascular disease can coexist and possibly interact with MS, improvements in the reliability of ways to differentiate MS from novel antibody-mediated CNS disorders (such as anti-aquaporin-4 antibody and myelin-oligodendrocyte glycoprotein antibody-associated diseases) and advances in MRI techniques. In this Review, MAGNIMS updates the imaging features that differentiate the most common mimics of MS, particularly age-related cerebrovascular disease and neuromyelitis optica, from MS itself. We also provide a pragmatic summary of the clinically useful MRI features that distinguish MS from its mimics and discuss the future of nonconventional techniques that have identified promising disease-specific features

Physicians&apos; guideline adherence is associated with long-term heart failure mortality in outpatients with heart failure with reduced ejection fraction: the QUALIFY international registry

Background: Physicians&apos; adherence to guideline-recommended therapy is associated with short-term clinical outcomes in heart failure (HF) with reduced ejection fraction (HFrEF). However, its impact on longer-term outcomes is poorly documented. Here, we present results from the 18-month follow-up of the QUALIFY registry. Methods and results: Data at 18 months were available for 6118 ambulatory HFrEF patients from this international prospective observational survey. Adherence was measured as a continuous variable, ranging from 0 to 1, and was assessed for five classes of recommended HF medications and dosages. Most deaths were cardiovascular (CV) (228/394) and HF-related (191/394) and the same was true for unplanned hospitalizations (1175 CV and 861 HF-related hospitalizations, out of a total of 1541). According to univariable analysis, CV and HF deaths were significantly associated with physician adherence to guidelines. In multivariable analysis, HF death was associated with adherence level [subdistribution hazard ratio (SHR) 0.93, 95% confidence interval (CI) 0.87–0.99 per 0.1 unit adherence level increase; P = 0.034] as was composite of HF hospitalization or CV death (SHR 0.97, 95% CI 0.94–0.99 per 0.1 unit adherence level increase; P = 0.043), whereas unplanned all-cause, CV or HF hospitalizations were not (all-cause: SHR 0.99, 95% CI 0.9–1.02; CV: SHR 0.98, 95% CI 0.96–1.01; and HF: SHR 0.99, 95% CI 0.96–1.02 per 0.1 unit change in adherence score; P = 0.52, P = 0.2, and P = 0.4, respectively). Conclusion: These results suggest that physicians&apos; adherence to guideline-recommended HF therapies is associated with improved outcomes in HFrEF. Practical strategies should be established to improve physicians&apos; adherence to guidelines. © 2019 The Authors. European Journal of Heart Failure © 2019 European Society of Cardiolog