Safety of botulinum toxin for dysphagia in oculopharyngeal muscular dystrophy

Despite multiple studies reporting marked benefit of botulinum toxin (BTX) for treatment of cricopharyngeal dysphagia, little is known about its safety for this indication. We examined the safety of cricopharyngeal BTX for dysphagia in oculopharyngeal muscular dystrophy (OPMD). We reviewed records of patients with OPMD who received cricopharyngeal BTX. Twenty-four patients underwent 66 procedures. Overall adverse event frequency was 44%. The most common adverse events were dysphonia (24%) and worsened dysphagia (14%). Logistic regression demonstrated that dose was a significant predictor of worsened dysphagia (P=0.036) and of the composite event of dysphonia or worsened dysphagia (P=0.009). There was a non-significant trend for dose as a predictor of dysphonia (P=0.073). 59% of procedures were associated with symptomatic improvement. While BTX appears to be beneficial for treatment of dysphagia in OPMD, caution is warranted when injecting the cricopharyngeus muscle due to dose-related risk of dysphonia or worsened dysphagia

The value of b0 images obtained from diffusion-weighted echo planar sequences for the detection of intracranial hemorrhage compared with GRE sequence

AbstractPurposeOur aim was to evaluate the clinical utility of b0EPI images obtained from diffusion sequence for the detection of the intracranial hemorrhagic lesions, especially acute intracerebral bleeds thereby shorten the scan time particularly in the critical acute cases of stroke.Materials and methodsAmong all consecutive MR brain studies performed in our department last year, we retrospectively selected those who followed the following criteria: (1) clinically suspected or radiographically confirmed acute infarction or hemorrhage. (2) MRI imaging including DWI and T2∗ images. Sensitivity of hemorrhage detection, conspicuity of lesions, and diagnostic certainty were compared between the b0EPI and GRE sequences.ResultsThere were 77 hemorrhagic lesions with a variety of pathogeneses in various locations. 76/77 (98.7%) of these lesions were hemorrhagic (hypointense) on the GRE sequences, whereas 61 (79.2%) were characterized as hemorrhagic on b0EPI images, and 16 (20.8%) were not detected. The overall difference in hemorrhage conspicuity/diagnostic certainty between GRE and b0EPI sequences was statistically significant (P<.05).Conclusionb0EPI sequence, although shorter in acquisition time, was inferior to GRE imaging in the detection of acute and chronic intracerebral hemorrhage

Southern Africa crustal anisotropy reveals coupled crust-mantle evolution for over 2 billion years

The long-term stability of Precambrian continental lithosphere depends on the rheology of the lithospheric mantle as well as the coupling between crust and mantle lithosphere, which may be inferred by seismic anisotropy. Anisotropy has never been detected in cratonic crust. Anisotropy in southern Africa, detected by the seismological SKS-splitting method, usually is attributed to the mantle due to asthenospheric flow or frozen-in features of the lithosphere. However, SKS-splitting cannot distinguish between anisotropy in the crust and the mantle. We observe strong seismic anisotropy in the crust of southern African cratons by Receiver Function analysis. Fast axes are uniform within tectonic units and parallel to SKS axes, orogenic strike in the Limpopo and Cape fold belts, and the strike of major dyke swarms. Parallel fast axes in the crust and mantle indicate coupled crust-mantle evolution for more than 2 billion years with implications for strong rheology of the lithosphere