Leptomeningeal Collateral State: Associated Factors and Impact on Functional Outcome in Ischemic Stroke

Aim: To determine factors associated with leptomeningeal collateral state (LCS) and impact of LCS on functional outcome in patients with ischemic stroke caused by middle cerebral artery (MCA) occlusion and treated with intravenous thrombolysis (IT) or mechanical thrombectomy (MT). Objectives: To determine the rate of good and bad LCS on CT angiography (CTA) in patients with ischemic stroke caused by MCA occlusion and treated with IT or MT; to evaluate the associations between LCS and age, gender, cardiovascular risk factors, mean arterial blood pressure (MAP), hematocrit (Ht), International Normalized Ratio (INR), lipid profile; to evaluate the associations between LCS and time from symptom onset to CTA, localization of MCA occlusion; to evaluate the impact of LCS on the initial neurological deficit (NIH stroke scale) and functional outcome (Barthel index (BI) at discharge from hospital). Methods: Good and bad LCS were determined by the modified Tan classification on CTA and associations between LCS and various factors were explored. Then patients were grouped into those with good or bad functional outcome (BI threshold 60 points), and impact of LCS on functional outcome was explored. Results: Good LCS was present in 66,67%, bad – in 33,33% of patients. LCS was not associated with age, gender, cardiovascular risk factors, MAP, Ht, INR, time from symptom onset to CTA. Higher high density lipoprotein (HDL) concentration was associated with better LCS (odds ratio (OR) per 0,1 mmol/l – 1,799, 95% confidence interval (CI) 1,113-2,908, p=0,017). All patients with bad LCS had a proximal MCA occlusion (p=0,005). Initial NIH stroke scale score was higher in patients with bad LCS (p=0,003). Good LCS was associated with good functional outcome (OR 17,000, CI 1,942-148,849, p=0,010). Conclusions: Good LCS was twice as common as bad LCS; Among Lithuanians, cardiovascular risk factors (except HDL), age, gender, markers of blood viscosity were not associated with LCS, but associations with hypertension, MAP and total cholesterol could not be confidently excluded. Higher HDL concentration was associated with good LCS; Time from symptom onset to CTA was not associated with LCS, proximal MCA occlusion was associated with bad LCS; Good LCS was associated with a lower initial neurological deficit and good functional outcome

Retained Glass Fragment in the Cervical Spinal Canal in a Patient with Acute Transverse Myelitis: A Case Report and Literature Review

A 50-year-old male presented with a one-day history of right leg weakness, numbness, and urinary retention. Weakness was present for two weeks but worsened significantly during the last 24 hours. On the right there was sensory loss in the leg and below the Th8 dermatome. On the left there was sensory loss below the Th10 dermatome and distal loss of temperature sensation. Past medical history revealed a cervical trauma 30 years ago when a glass chip lodged into the left side of the neck. The patient did not seek medical attention after removing it himself. No neurological symptoms followed the incident. No cervical manipulation or other physical trauma occurred before current symptom onset. Magnetic resonance (MR) imaging showed features consistent with myelitis at the level of C4–Th3. At the level of C6–C7, a T1 and T2 hypointense lesion was noted. On computed tomography, this lesion was hyperdense and occupied the spinal canal and the left intervertebral foramen. It was deemed to be a glass fragment. Surgical removal was withheld because the fragment was clinically silent for 30 years, the risk of surgical removal would outweigh the benefits and the patient did not prefer surgical treatment. Acute demyelinating transverse myelitis was diagnosed and treated with methylprednisolone. 10 months later MR features of myelitis resolved and the patient’s neurological condition improved. Our case shows that foreign bodies in the cervical spinal canal can remain asymptomatic for up to 30 years. In the case of a long asymptomatic retention period the need for surgical removal of a foreign body must be carefully evaluated, taking into account the probability that a foreign body is the cause of current symptoms, risk of a foreign body causing damage in the future, risk of damage to the spinal cord during removal, and probability of therapeutic success

Odor Identification and Regional Gray Matter Atrophy in Patients with Alzheimer’s Disease, Parkinson’s Disease, and the Healthy Elderly: A Cross-Sectional Structural MRI Study

Multiple associations between impaired olfactory performance and regional cortical and deep gray matter atrophy have been reported in separate studies of patients with Alzheimer’s disease (AD), Parkinson’s disease (PD), and of the healthy elderly. We aimed to evaluate such possible associations among these populations in a unified manner. Twenty AD, twenty PD patients’ and twenty healthy age- and sex-matched controls’ odor identification performance was assessed with the Lithuanian adaptation of the Sniffin’ Sticks 12 odor identification test, followed by morphometric gray matter analysis by MRI using FreeSurfer. AD patients had significantly lower cognitive performance than both PD patients and the healthy elderly, as evaluated with the Mini-Mental State Examination (MMSE). Odor identification performance was significantly worse in AD and PD patients compared with the healthy elderly; AD patients performed slightly worse than PD patients, but the difference was not statistically significant. Among patients with AD, worse odor identification performance was initially correlated with atrophy of multiple cortical and deep gray matter regions known to be involved in olfactory processing, however, only two measures—decreased thicknesses of the right medial and left lateral orbitofrontal cortices—remained significant after adjustment for possible confounders (age, MMSE score, and global cortical thickness). Among patients with PD and the healthy elderly we found no similar statistically significant correlations. Our findings support the key role of the orbitofrontal cortex in odor identification among patients with AD, and suggest that correlations between impaired odor identification performance and regional gray matter atrophy may be relatively more pronounced in AD rather than in PD

Diagnostic Ability of Structural Transcranial Sonography in Patients with Alzheimer’s Disease

The aim of this study was to assess the diagnostic ability of transcranial sonography (TCS) for the evaluation of the medial temporal lobe (MTL) in Alzheimer’s disease (AD). Standard neuropsychological evaluation, TCS and 1.5 T MRI were performed for 20 patients with AD and for 20 age- and sex-matched healthy controls in a prospective manner. Measurements of the size of the third ventricle and heights of the MTL (A) and the choroidal fissure (B) were performed twice on each side by two independent neurosonologists for all participants. On MRI, both conventional and volumetric analyses of the third ventricle and hippocampus were performed. Receiver operating characteristic (ROC) curves analyses were applied. Height of the MTL on TCS had sensitivities of 73.7% (right)/63.2%(left) and specificities of 65% (right)/65–70% (left) Area under a curve (AUC) 75.4–77.2% (right), 60.4–67.8% (left)) for AD. A/B ratio on TCS had sensitivities of 73.7% (right)/57.9% (left) and specificities of 70.0% (right)/55.0% (left) (AUC 73.3% (right), 60.4% (left)) by the experienced neurosonologist, and sensitivities of 78.9% (right and left) and specificities of 60.0% (right)/65.0% (left) (AUC 77.8–80.0%) by the inexperienced neurosonologist for AD. On MRI, linear measurement of the hippocampus and parahippocampal gyrus height had sensitivities of 84.2% (right)/89.5% (left) and specificities of 80.0% (right)/85% (left) (AUC 86.1–92.9%) for AD. Hippocampal volume had sensitivities of 70% (right and left) and specificities of 75% (right)/80% (left) (AUC 77.5–78%) for AD. Atrophy of the right MTL in AD could be detected on TCS with a good diagnostic ability, however MRI performed better on the left