Real-time neuropsychological testing during endovascular occlusion of a fusiform aneurysm in the left middle cerebral artery

Real-time neuropsychological testing (RTNT) was used to test whether permanent endovascular occlusion of the insular branch of the left middle cerebral artery (MCA) helped avoid cognitive and neurological complications following the procedure. This patient suffered from a fusiform aneurysm along the insular branch of the MCA in the territory supplied in the left inferior frontal gyrus, around Broca's area. Pre-intervention neuropsychological testing was normal.During temporary occlusion lasting 25 min, the patient continuously performed at ceiling on the RTNT neuropsychological and language tasks. Thus, permanent occlusion followed. In addition, fMRI was used to investigate changes induced by the procedure. In the language domain, rearrangements in activation in Broca's area and in the left insula were detected by silent and overt production tasks. In the motor domain, decreased activation in the sensorimotor cortex during right-hand movement control was reported along with decreased right-hand sensibility. Post-intervention neuropsychological testing was normal.Results showed that RTNT can be used reliably during temporary occlusion in the specific case of a quite small branch of the MCA to provide continuous feedback on the patient's cognitive and language status and is predictive of post-intervention functioning. In addition, the study enabled us to detect changes in functional organization triggered by temporary occlusion of a branch of the left middle cerebral artery. Keywords: Temporary occlusion testing, Aneurysm treatment outcome, Functional recovery, Inferior frontal gyrus, fMRI, Plasticity, Speech articulatio

Tricks and Pitfalls in the Diagnosis of Cerebral Venous Thrombosis

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Progressive and Fatal Brainstem Stroke in Systemic Giant Cell Arteritis

9N/AreservedmixedmixedPoretto, Valentina; Piffer, Silvio; Bignamini, Valeria; Tranquillini, Enzo; Donner, Davide; Cavatorta, Francesco Paolo; Barbareschi, Mattia; Petralia, Benedetto; Giometto, BrunoPoretto, Valentina; Piffer, Silvio; Bignamini, Valeria; Tranquillini, Enzo; Donner, Davide; Cavatorta, Francesco Paolo; Barbareschi, Mattia; Petralia, Benedetto; Giometto, Brun

Magnetic Resonance Imaging Derived Biomarkers of {IDH} Mutation Status and Overall Survival in Grade {III} Astrocytomas

The evaluation of the isocitrate dehydrogenase (IDH) mutation status in the glioma decision-making process has diagnostic, prognostic and therapeutic implications. The aim of this study was to evaluate whether conventional magnetic resonance imaging (MRI) and apparent diffusion coefficient (ADC) can noninvasively predict the most common IDH mutational status (R132H) in GIII-astrocytomas and the overall survival (OS). Hence, twenty-two patients (9-F, 13-M) with a histological diagnosis of GIII-astrocytoma and evaluation of IDH-mutation status (12-wild type, 10-mutant) were retrospectively evaluated. Imaging studies were reviewed for the morphological feature and mean ADC values (ADCm). Statistics included a Fisher\u2019s exact test, Student\u2019s t-test, Spearman\u2019s Test and receiver operating characteristic analysis. A p 64 0.05 value was considered statistically significant for all the tests. A younger age and a frontal location were more likely related to mutational status. IDH-wild type (Wt) exhibited a slight enhancement (p = 0.039). The ADCm values in IDH-mutant (Mut) patients were higher than those of IDH-Wt patients (p < 0.0004). The value of ADC 65 0.99 7 10 123 mm2/s emerged as a \u201ccut-off\u201d to differentiate the mutation state. In the overall group, a positive relationship between the ADCm values and OS was detected (p = 0.003; r = 0.62). Adding quantitative measures of ADC values to conventional MR imaging could be used routinely as a noninvasive marker of specific molecular patterns

Imaging of Substantia Nigra in Parkinson’s Disease: A Narrative Review

none13noParkinson’s disease (PD) is a progressive neurodegenerative disorder, characterized by motor and non-motor symptoms due to the degeneration of the pars compacta of the substantia nigra (SNc) with dopaminergic denervation of the striatum. Although the diagnosis of PD is principally based on a clinical assessment, great efforts have been expended over the past two decades to evaluate reliable biomarkers for PD. Among these biomarkers, magnetic resonance imaging (MRI)-based biomarkers may play a key role. Conventional MRI sequences are considered by many in the field to have low sensitivity, while advanced pulse sequences and ultra-high-field MRI techniques have brought many advantages, particularly regarding the study of brainstem and subcortical structures. Nowadays, nigrosome imaging, neuromelanine-sensitive sequences, iron-sensitive sequences, and advanced diffusion weighted imaging techniques afford new insights to the non-invasive study of the SNc. The use of these imaging methods, alone or in combination, may also help to discriminate PD patients from control patients, in addition to discriminating atypical parkinsonian syndromes (PS). A total of 92 articles were identified from an extensive review of the literature on PubMed in order to ascertain the-state-of-the-art of MRI techniques, as applied to the study of SNc in PD patients, as well as their potential future applications as imaging biomarkers of disease. Whilst none of these MRI-imaging biomarkers could be successfully validated for routine clinical practice, in achieving high levels of accuracy and reproducibility in the diagnosis of PD, a multimodal MRI-PD protocol may assist neuroradiologists and clinicians in the early and differential diagnosis of a wide spectrum of neurodegenerative disorders.noneFeraco, Paola; Gagliardo, Cesare; La Tona, Giuseppe; Bruno, Eleonora; D’angelo, Costanza; Marrale, Maurizio; Del Poggio, Anna; Malaguti, Maria Chiara; Geraci, Laura; Baschi, Roberta; Petralia, Benedetto; Midiri, Massimo; Monastero, RobertoFeraco, Paola; Gagliardo, Cesare; La Tona, Giuseppe; Bruno, Eleonora; D’angelo, Costanza; Marrale, Maurizio; Del Poggio, Anna; Malaguti, Maria Chiara; Geraci, Laura; Baschi, Roberta; Petralia, Benedetto; Midiri, Massimo; Monastero, Robert

Planning Brain Tumor Resection Using a Probabilistic Atlas of Cortical and Subcortical Structures Critical for Functional Processing: A Proof of Concept

International audienceBackground: Functional preoperative planning for resection of intrinsic brain tumors in eloquent areas is still a challenge. Predicting subcortical functional framework is especially difficult. Direct electrical stimulation (DES) is the recommended technique for resection of these lesions. A reliable probabilistic atlas of the critical cortical epicenters and subcortical framework based on DES data was recently published.Objective: To propose a pipeline for the automated alignment of the corticosubcortical maps of this atlas with T1-weighted MRI.Methods: To test the alignment, we selected 10 patients who underwent resection of brain lesions by using DES. We aligned different cortical and subcortical functional maps to preoperative volumetric T1 MRIs (with/without gadolinium). For each patient we quantified the quality of the alignment, and we calculated the match between the location of the functional sites found at DES and the functional maps of the atlas.Results: We found an accurate brain extraction and alignment of the functional maps with both the T1 MRIs of each patient. The matching analysis between functional maps and functional responses collected during surgeries was 88% at cortical and, importantly, 100% at subcortical level, providing a further proof of the correct alignment.Conclusion: We demonstrated quantitatively and qualitatively the reliability of this tool that may be used for presurgical planning, providing further functional information at the cortical level and a unique probabilistic prevision of distribution of the critical subcortical structures. Finally, this tool offers the chance for multimodal planning through integrating this functional information with other neuroradiological and neurophysiological techniques

Italian multicenter experience with flow-diverter devices for intracranial unruptured aneurysm treatment with periprocedural complications—a retrospective data analysis

Introduction We report the experiences of 25 Italian centers, analyzing intra- and periprocedural complications of endovascular treatment of intracranial aneurysms using Silk (Balt Extrusion, Montmorency, France) and pipeline embolization devices (EV3 Inc, Irvine California). Methods Two hundred seventy-three patients with 295 cerebral aneurysms, enrolled in 25 centers in Italy and treated with the new flow-diverter devices, were evaluated; 142 patients were treated with Silk and 130 with pipeline (in one case, both devices were used). In 14 (5.2 %) cases devices were used with coils. Aneurysm size was >15 mm in 46.9 %, 5–15 mm in 42.2 %, and <5 mm in 10.8 %. Aneurysm locations were supraclinoid internal carotid artery (ICA) in 163 cases (55.2 %), cavernous ICA in 76 (25.7 %), middle cerebral artery in 11 (3.7 %), PCoA in 6 (2 %), and ACoA in 2 (0.7 %); the vertebrobasilar system accounted for 32 cases (10.8 %) and PCA in 5 (1.7 %). Results Technical adverse events occurred with 59 patients (21.6 %); 5 patients died after ischemic events, 10 to hemorrhagic complications, and 1 from external ventricular drain positioning. At 1 month, morbidity and mortality rates were 3.7 % and 5.9 %, respectively Conclusion Our retrospective study confirms that morbidity and mortality rates in treatment with FDD of unruptured wide-neck or untreatable cerebral aneurysms do not differ from those reported in the largest series