Depression and anxiety in acute ischemic stroke involving the anterior but not paramedian or inferolateral thalamus

Background and objectives: Emotional and cognitive deficits are prevalent in strokes involving the thalamus. In contrast to cognitive deficits, emotional deficits have not been studied prospectively in isolated thalamic stroke. Methods: In 37 ischemic thalamic stroke patients (57.0 [50.0; 69.5] years [median (Q1; Q3)], 21 males, 5 anterior, 12 paramedian, 20 inferolateral vascular territory), and 37 non-stroke control patients matched for age and sex, we prospectively examined depression, anxiety, activities of daily living, and quality of life at 1, 6, 12, and 24 months post-stroke using the Hospital-Anxiety-and-Depression Scale (HADS), Nürnberger-Alters-Alltagsaktivitäten scale (NAA), and Short Form-36 (SF36) questionnaire. Voxel-based lesion-symptom mapping (VLSM) and lesion-subtraction analyzes were performed to determine associations between questionnaire scores and thalamic stroke topography. Results: At 1 month post-stroke, anterior thalamic stroke patients had higher depression scores [8.0 (7.5; 10.5)] than paramedian [4.5 (1.0; 5.8)] and inferolateral [4.0 (1.0; 7.0)] thalamic stroke patients. Furthermore, anterior thalamic stroke patients had higher anxiety scores [11.0 (8.0; 14.5)] than their matched controls [2.5 (2.0; 2.5)], paramedian [4.5 (1.0; 5.8)] and inferior [4.0 (1.0; 7.0)] thalamic stroke patients. Depression and anxiety scores in anterior thalamic stroke patients remained high across the follow-up [depression: 9.0 (3.5; 13,8); anxiety:10.05 (2.8, 14.5)]. Physical health assessed by SF36 was intact in anterior [1 month post-stroke: T-score = 55.9 (37.0; 57.6)] but reduced in inferolateral [44.5(32.4; 53.1)] thalamic stroke, whereas mental health was reduced in anterior thalamic stroke [32.0 (29.8; 47.3)]. VLSM confirmed that voxels in the anterior thalamus around Montreal Neurological Institute (MNI) coordinates X = −8, Y = −12, Z = 2 were more often affected by the stroke in depressed (HADS-score ≥ 8) than non-depressed (HADS-score < 8) patients and voxels around coordinates X = −10, Y = −12, Z = 2 were more often affected in anxious (HADS-score ≥ 8) than non-anxious (HADS-score < 8) patients. Conclusion: Anterior, but not paramedian or inferolateral thalamic stroke was associated with depression and anxiety. Even though our results are mostly significant in the left thalamus, this observation on stroke laterality might be confounded by the fact that the right hemisphere was underrepresented in our study

Lhermitte-Duclos disease presenting with positron emission tomography-magnetic resonance fusion imaging: a case report

<p>Abstract</p> <p>Introduction</p> <p>Lhermitte-Duclos disease or dysplastic gangliocytoma of the cerebellum is an extremely rare tumor. It is a slowly enlarging mass within the cerebellar cortex. The majority of cases are diagnosed in the third or fourth decade of life.</p> <p>Case presentation</p> <p>We report the case of a 37-year-old Caucasian woman who underwent positron emission tomography-computed tomography with fluorine-18-fluorodeoxyglucose for evaluation of a solitary lung node. No pathological uptake was detected in the solitary lung node but the positron emission tomography-computed tomography of her brain showed intense tracer uptake, suggestive of a malignant neoplasm, in a mass in her left cerebellar lobe. Our patient had experienced two years of occipital headache and movement disorder. Subsequently, magnetic resonance imaging was performed with contrast agent administration, showing a large subtentorial mass in her left cerebellar hemisphere, with compression and dislocation of the fourth ventricle. Metabolic data provided by positron emission tomography and morphological magnetic resonance imaging views were fused in post-processing, allowing a diagnosis of dysplastic gangliocytoma with increased glucose metabolism. Total resection of the tumor was performed and histological examination confirmed the diagnosis of Lhermitte-Duclos disease.</p> <p>Conclusions</p> <p>Our case indicates that increased uptake of fluorine-18-fluorodeoxyglucose may be misinterpreted as a neoplastic process in the evaluation of patients with Lhermitte-Duclos disease, but supports the usefulness of integrated positron emission tomography-magnetic resonance imaging in the exact pathophysiologic explanation of this disease and in making the correct diagnosis. However, an accurate physical examination and exact knowledge of clinical data is of the utmost importance.</p

Too big to fail ? ! Leçons de la crise financière

This article examines the emergence and evolution of the “ Too-Big-To-Fail” (TBTF) doctrine based on various case studies, identifying moral hazard as the cause for externalities. It examines the role of TBTF within the recent financial crisis with regard to its contribution to and appearance in the crisis. In drawing lessons from the current crisis, a broader concept of systemic relevance is developed building on bank characteristics beyond sheer size. Referred to as “ Systemically Important Financial Institutions” by the Financial Stability Board, it is argued that these banks should be regulated rather than downsized or broken up considering the advantages of having large diversified global banks. The article evaluates FSB’s proposed regulatory measures, including capital surcharges, resolution regimes, enhanced supervision and improved core financial infrastructure, and identifies resolution regimes as the most efficient mechanisms to counter TBTF. If designed appropriately, such resolution regimes could convert TBTF into TBDF, or “ Too Big for Disorderly Failure”. Finally, the article warns that in reaching a new equilibrium in the financial system, unintended consequences such as concentration, competitive distortion and regulatory arbitrage have to be taken into account. Classification JEL : G21, G28, E51.Cet article examine l’apparition et l’évolution de la doctrine too big to fail (TBTF) («trop grand pour faire faillite » ) à la lumière de plusieurs études de cas et identifie l’aléa moral comme cause d’externalités. Il analyse le rôle joué par la doctrine TBTF dans la récente crise financière et se penche sur son apparition et sa participation à ladite crise. Si l’on tire les conséquences de la crise, le concept élargi d’importance systémique se nourrit d’autres caractéristiques que la taille des banques. Au vu des avantages que présentent les grandes banques globales diversifiées, ces «institutions financières d’importance systémique » (IFIS), comme les appelle le Conseil de stabilité financière, devraient faire l’objet de réglementations plutôt que se voir réduites ou démantelées. L’article propose une analyse des mesures réglementaires proposées par le CSF, notamment les surcharges en capital, le renforcement du contrôle, l’amélioration de l’infrastructure financière clé et les régimes de résolution, ce dernier mécanisme étant le plus efficient pour limiter les TBTF. Bien conçus, ces régimes de résolution pourraient convertir les TBTF en TBDF (too big for disorderly failure), des établissements trop grands pour une faillite chaotique. Enfin l’article souligne que pour parvenir à un nouvel équilibre du système financier, il faut tenir compte des conséquences involontaires telles que la concentration, la distorsion de la concurrence et l’arbitrage réglementaire. Classification JEL : G21, G25, E51.Moenninghoff Sébastien C., Wieandt Axel. Too big to fail ? ! Leçons de la crise financière. In: Revue d'économie financière, n°101, 2011. Le risque systémique 2. Repenser la supervision. pp. 231-257

The perennial challenge to counter Too-Big-to-Fail in banking: Empirical evidence from the new international regulation dealing with Global Systemically Important Banks

This paper provides evidence on how the new international regulation on Global Systemically Important Banks (G-SIBs) impacts the market value of large banks. We analyze the stock price reactions for the 300 largest banks from 52 countries across 12 relevant regulatory announcement and designation events. We observe that the new regulation negatively affects the value of the newly regulated banks, yet that the official designation of banks as “globally systemically important” itself has a partly offsetting positive impact. A cross-sectional analysis of the valuation effects with respect to, for example, government ownership of banks supports the view that the positive reaction to these designations can be attributed to a Too-Big-to-Fail (TBTF) perception by investors. The fact that these valuation effects emerge from a regulation specifically designed to reduce the costs and risks of Too-Big-to-Fail demonstrates the inherently paradoxical nature of the new regulation. These results further suggest that even though the individual components of the regulation have been effective, revealing the identities of G-SIBs eliminated ambiguity about the presence of government guarantees, and thereby may have run counter to the regulators’ intent to contain the effects of TBTF

The perennial challenge to counter Too-Big-To-Fail in banking: Empirical evidence from the new international regulation dealing with Global Systemically Important Banks

This paper provides evidence on how the new international regulation on Global Systemically Important Banks (G-SIBs) impacts the market value of large banks. We analyze the stock price reactions for the 300 largest banks from 52 countries across 12 relevant regulatory announcement and designation events. We observe that the new regulation negatively affects the value of the newly regulated banks, yet that the official designation of banks as “globally systemically important” itself has a partly offsetting positive impact. A cross-sectional analysis of the valuation effects with respect to, for example, government ownership of banks supports the view that the positive reaction to these designations can be attributed to a Too-Big-to-Fail (TBTF) perception by investors. The fact that these valuation effects emerge from a regulation specifically designed to reduce the costs and risks of Too-Big-to-Fail demonstrates the inherently paradoxical nature of the new regulation. These results further suggest that even though the individual components of the regulation have been effective, revealing the identities of G-SIBs eliminated ambiguity about the presence of government guarantees, and thereby may have run counter to the regulators’ intent to contain the effects of TBTF.publisher: Elsevier articletitle: The perennial challenge to counter Too-Big-to-Fail in banking: Empirical evidence from the new international regulation dealing with Global Systemically Important Banks journaltitle: Journal of Banking & Finance articlelink: http://dx.doi.org/10.1016/j.jbankfin.2015.01.017 content_type: article copyright: Copyright © 2015 Elsevier B.V. All rights reserved.status: publishe

Evolution of Neuropsychological Deficits in First-Ever Isolated Ischemic Thalamic Stroke and Their Association With Stroke Topography: A Case-Control Study

Supplemental Material is available at: https://www.ahajournals.org/doi/suppl/10.1161/STROKEAHA.121.037750.Sources of funding: none