Reversible hypertensive brainstem encephalopathy coexistent with acute intracerebral hemorrhage

We report two cases of reversible hypertensive brainstem encephalopathy (RHBE) syndrome with other concurrent manifestations of malignant hypertension. RHBE was accompanied by hypertensive putaminal hemorrhage in one case, and by intra-ventricular hemorrhage resulting acute obstructive hydrocephalus along with multiple small acute infarctions in the other. Diffusion-weighted imaging and corresponding apparent diffusion coefficient mapping disclosed increased diffusion suggestive of vasogenic edema centered in the pons. No lesion indicative for posterior reversible encephalopathy syndrome (PRES) was noted in the supratentorial regions. These cases indicate that mechanisms involved in development of RHBE and hypertensive PRES may have some differences, albeit both share main lines. These cases also underline that awareness and knowledge about relatively specific clinic-radiological syndrome caused by RHBE seem to be critical. Acute treatment and early prognostification are just only accurate with such a familiarity

The Association of Cognitive Impairment with Gray Matter Atrophy and Cortical Lesion Load in Clinically Isolated Syndrome

Background: Multiple sclerosis can impair cognition from the early stages and has been shown to be associated with gray matter damage in addition to white matter pathology. Objectives: To investigate the profile of cognitive impairment in clinically isolated syndrome (CIS), and the contribution of cortical inflammation, cortical and deep gray matter atrophy, and white matter lesions to cognitive decline. Methods: Thirty patients with clinically isolated syndrome and twenty demographically-matched healthy controls underwent neuropsychologic assessment through the Rao Brief Repeatable Battery, and brain magnetic resonance imaging with double inversion recovery using a 3T scanner. Results: Patients with clinically isolated syndrome performed significantly worse than healthy controls on tests that evaluated verbal memory, visuospatial learning and memory, and verbal fluency. Significant deep gray matter atrophy was found in the patients but cortical volume was not lower than the controls. Visual memory tests correlated with the volume of the hippocampus, cerebral white matter and deep gray matter structures and with cerebellar cortical atrophy. Cortical or white matter lesion load did not affect cognitive test results. Conclusion: In our patients with CIS, it was shown that cognitive impairment was mainly related to cerebral white matter, cerebellar cortical and deep gray matter atrophy, but not with cortical inflammation, at least in the early stage of disease. (C) 2016 Elsevier B.V. All rights reserved.Wo

Influence Of Cigarette Smoking On White Matter In Patients With Clinically Isolated Syndrome As Detected By Diffusion Tensor Imaging

PURPOSE Cigarette smoking has been associated with increased occurrence of multiple sclerosis (MS), as well as clinical disability and disease progression in MS. We aimed to assess the effects of smoking on the white matter (WM) in patients with clinically isolated syndrome (CIS) using diffusion tensor imaging. METHODS Smoker patients with CIS (n=16), smoker healthy controls (n=13), nonsmoker patients with CIS (n=17) and nonsmoker healthy controls (n=14) were included. Thirteen regions-of-interest including nonenhancing T1 hypointense lesion and perilesional WM, and 11 normal-appearing white matter (NAWM) regions were drawn on color-coded fractional anisotropy (FA) maps. Lesion load was determined in terms of number and volume of WM hyperintensities. RESULTS A tendency towards greater lesion load was found in smoker patients. T1 hypointense lesions and perilesional WM had reduced FA and increased mean diffusivity to a similar degree in smoker and nonsmoker CIS patients. Compared with healthy smokers, smoker CIS patients had more extensive NAWM changes shown by increased mean diffusivity. There was no relationship between diffusion metrics and clinical disability scores, duration of the disease and degree of smoking exposure. CONCLUSION Smoker patients showed a tendency towards having greater number of WM lesions and displayed significantly more extensive NAWM abnormalities.Wo

Analysis Of Peripapillary Retinal Nerve Fiber Layer And Macular Volume In Patients With Multiple Sclerosis, Neuromyelitis Optica Spectrum Disorders, And Healthy Controls Using Spectral Domain Optical Coherence Tomography In A Turkish Cohort

Objective: To compare the peripapillary retinal nerve fiber layer (pRNFL) thickness and macular volume in patients with multiple sclerosis (MS), neuromyelitis optica spectrum disorders (NMOSD), and healthy controls. Materials and Methods: This study used spectral domain-optical coherence tomography to measure pRNFL and the volume of retinal layers at the macula. Forty patients with MS or NMOSD and 19 healthy controls were enrolled. Results: After at least one clinical episode of optic neuritis, the average pRNFL for NMOSD [60 mu m (34-105)] and patients with MS [85 mu m (41-109)] were lower than in healthy controls [99 mu m (88-109)], and patients with NMOSD had significantly lower pRNFL compared with patients with MS (p=0.002). Foveal volume did not differ between optic neuritis eyes of patients with NMOSD and MS (NMOSD 1.18 +/- 0.3 mm(3), MS 1.82 +/- 2.07 mm(3)). The mean pRNFL values in seroneguive NMOSD eyes [58 mu m (range, 47-111)] tended to be thinner compared with seropositive NMOSD eyes [76 mu m (range, 42-105)]. This finding was not considered to he statistically significant. Conclusion: Our study revealed that both foveal (area in a 1.5 mm ETDRS ring) and coral macular volume (area in a 6 mm ETDRS ring) were lower in both patients with MS and NMOSD compared with healthy controls. Optic neuritis of NMOSD is associated with a thinner average RNFL compared with MS, suggesting earlier axonal injury in the affected optic nerves.WoSScopu

Assessment of the Effect of Cigarette Smoking on Regional Brain Volumes and Lesion Load in Patients with Clinically Isolated Syndrome

Purpose: Smoking has been associated with an increased risk of developing multiple sclerosis, disease progression and clinical disability. We detected the effects of smoking on regional brain volumes and lesion load in patients with clinically isolated syndrome using quantitative magnetic resonance imaging. Materials and Methods: Smoker patients (n = 16), smoker healthy controls (n = 13), non-smoker patients (n = 17) and non-smoker healthy controls (n = 14) underwent magnetic resonance imaging and neocortical volumes were measured. Lesion load was calculated in terms of number and volume of white matter hyperintensities. Results: Smoking was associated with increased gray matter volumes in several regions of the brain. A tendency towards greater lesion load in smoker patients was found. Smoking duration was significantly negatively correlated with intracranial volume and left hemisphere cortical gray matter volume. There was no relationship between regional brain volumes and clinical disability scores, lesion load duration of the disease and degree of smoking exposure. Conclusions: Clinically isolated syndrome related regional brain atrophy might vary in extent and severity with smoking. Despite increased lesion load, less cortical and deep gray matter damage with a possible neuroprotective effect occurs in smoking.Wo

Neuroinvasive Listeriosis Could Petechial Hemorrhages be a Diagnostic Clue?

Introduction:Listeria monocytogenes-related central nervous system infections may involve the cerebral parenchyma. Meningitis and meningoencephalitis are the most commonly seen forms and mainly affect immunocompromised patients; however, a less frequent form, rhombencephalitis, can occur in otherwise healthy people. Early treatment with appropriate antibiotic therapy is crucial for this otherwise fatal disorder. However, it is not always possible to rapidly establish the diagnosis because of varying presentations and discrepancies in diagnostic tests.Case Report:Herein we report 3 cases of listerial infections involving the central nervous system parenchyma, with versatile diagnostic challenges and related possible solutions and radiologic hints to overcome similar issues in the future.Conclusions:We point out the importance of nonconventional magnetic resonance imaging techniques in the diagnosis, as we detected petechial hemorrhages in the brain parenchyma in all cases, which can be a diagnostic clue

Neuromyelitis Optica and Neuromyelitis Optica Spectrum Disorder Patients in Turkish Cohort Demographic, Clinical, and Laboratory Features

Background: Neuromyelitis optica (NMO) is an immune-mediated, chronic relapsing, inflammatory disease characterized by severe attacks of optic neuritis and myelitis