This document reviews various imaging modalities used to examine the central nervous system in patients with systemic lupus erythematosus (SLE). It discusses both morphological modalities like magnetic resonance imaging (MRI) and functional modalities like positron emission tomography (PET) and single photon emission computed tomography (SPECT). MRI is considered the gold standard, and the document focuses on specific MRI sequences that can help identify abnormalities and differentiate between inflammatory and ischemic lesions in the brain. These sequences allow for a better understanding of central nervous system involvement in SLE patients.
The document discusses various neuroimaging techniques used to study the brain, including their basic principles and psychiatric applications. It describes CT, MRI, MRS, fMRI, and SPECT, explaining what each measures, how they work, and what tissues appear as on the images. It provides examples of structural images and contrasts the advantages and disadvantages of the different modalities. It also outlines specific indications for neuroimaging in clinical practice and research into psychiatric disorders.
1) Neuroimaging studies of schizophrenia have found reductions in gray matter volume in brain regions like the left superior temporal gyrus, hippocampus, and amygdala.
2) White matter abnormalities have also been found in fiber tracts like the corpus callosum, uncinate fasciculus, and inferior fronto-occipital fasciculus in patients with schizophrenia.
3) Studies of first-episode patients suggest these changes may occur within the first year of illness, especially in auditory processing regions of the superior temporal gyrus.
The document summarizes the process of presurgical evaluation for epilepsy patients. It discusses how modern imaging techniques like video EEG monitoring, high-resolution MRI, fMRI, PET and SPECT are used to localize the epileptogenic zone noninvasively in most patients. When noninvasive methods are insufficient, invasive EEG monitoring using subdural or depth electrodes may be used. The goal is to precisely identify the brain area responsible for seizure generation to allow its surgical resection, while avoiding damage to critical functions. A classical example where surgery is often curative is mesial temporal lobe epilepsy.
This lab report discusses directional terms and planes of reference used in neuroanatomy. It defines terms like lateral, anterior, posterior, medial, dorsal, ventral, rostral, and caudal. It also discusses planes like sagittal, midsagittal, horizontal, and coronal. The report then discusses various types of neurophysiological assessments including CT scans, MRI, fMRI, PET scans, x-rays, staining, and their purposes in aiding diagnosis and defining normal and abnormal brain structures.
This document discusses the use of functional MRI (fMRI) in preoperative planning for brain tumor patients. fMRI can help assess the relationship between functionally eloquent brain regions and tumor location to minimize postoperative deficits. It describes different tasks used in fMRI like motor and language tasks. Validation studies show high sensitivity and specificity for motor mapping but more variable results for language mapping. The document also discusses limitations of fMRI like spatial uncertainty and tumor effects on BOLD signal. Overall, fMRI provides useful information to guide surgery when used appropriately with an understanding of its limitations.
An Evaluation of A Stroke Rehabilitation Study At Rotman Research InstituteJoanna (Yijing) Rong
This document provides an overview of the co-op placement of Joanna Rong at the Rotman Research Institute. The placement involved assisting with a stroke rehabilitation study comparing Music-Supported Rehabilitation (MSR) to Graded Repetitive Arm Supplementary Program (GRASP). Three assessment methods were used: magnetoencephalography (MEG), behavioral tests, and MRI scans. The document discusses the purpose and limitations of the assessments.
acute stroke for rehab physician - dr trilochan shrivastavamrinal joshi
1. The document discusses acute management and rehabilitation of stroke, providing information on types of strokes, risk factors, signs and symptoms, investigations, treatments, and rehabilitation approaches.
2. It covers diagnostic testing including imaging, medications, and interventional procedures for ischemic and hemorrhagic strokes.
3. Rehabilitation services are described including physical, occupational and speech therapy in various settings from inpatient to home-based care with the goal of improving functional abilities and outcomes for stroke patients.
1997 practice parameters for the indications for polysomnography and relate...alpha314
These clinical guidelines from the American Sleep Disorders Association provide recommendations for when polysomnography and related sleep studies are indicated in the diagnosis of various sleep disorders. The guidelines were developed by a task force that reviewed literature on the topic and consulted specialists. Key indications for polysomnography include diagnosing sleep-related breathing disorders, assessing positive airway pressure titration, and evaluating violent or injurious parasomnias. The guidelines also provide recommendations for when polysomnography may be indicated or is not routinely needed. The goal is to help ensure appropriate and cost-effective use of sleep testing procedures.
The document discusses various neuroimaging techniques used to study the brain, including their basic principles and psychiatric applications. It describes CT, MRI, MRS, fMRI, and SPECT, explaining what each measures, how they work, and what tissues appear as on the images. It provides examples of structural images and contrasts the advantages and disadvantages of the different modalities. It also outlines specific indications for neuroimaging in clinical practice and research into psychiatric disorders.
1) Neuroimaging studies of schizophrenia have found reductions in gray matter volume in brain regions like the left superior temporal gyrus, hippocampus, and amygdala.
2) White matter abnormalities have also been found in fiber tracts like the corpus callosum, uncinate fasciculus, and inferior fronto-occipital fasciculus in patients with schizophrenia.
3) Studies of first-episode patients suggest these changes may occur within the first year of illness, especially in auditory processing regions of the superior temporal gyrus.
The document summarizes the process of presurgical evaluation for epilepsy patients. It discusses how modern imaging techniques like video EEG monitoring, high-resolution MRI, fMRI, PET and SPECT are used to localize the epileptogenic zone noninvasively in most patients. When noninvasive methods are insufficient, invasive EEG monitoring using subdural or depth electrodes may be used. The goal is to precisely identify the brain area responsible for seizure generation to allow its surgical resection, while avoiding damage to critical functions. A classical example where surgery is often curative is mesial temporal lobe epilepsy.
This lab report discusses directional terms and planes of reference used in neuroanatomy. It defines terms like lateral, anterior, posterior, medial, dorsal, ventral, rostral, and caudal. It also discusses planes like sagittal, midsagittal, horizontal, and coronal. The report then discusses various types of neurophysiological assessments including CT scans, MRI, fMRI, PET scans, x-rays, staining, and their purposes in aiding diagnosis and defining normal and abnormal brain structures.
This document discusses the use of functional MRI (fMRI) in preoperative planning for brain tumor patients. fMRI can help assess the relationship between functionally eloquent brain regions and tumor location to minimize postoperative deficits. It describes different tasks used in fMRI like motor and language tasks. Validation studies show high sensitivity and specificity for motor mapping but more variable results for language mapping. The document also discusses limitations of fMRI like spatial uncertainty and tumor effects on BOLD signal. Overall, fMRI provides useful information to guide surgery when used appropriately with an understanding of its limitations.
An Evaluation of A Stroke Rehabilitation Study At Rotman Research InstituteJoanna (Yijing) Rong
This document provides an overview of the co-op placement of Joanna Rong at the Rotman Research Institute. The placement involved assisting with a stroke rehabilitation study comparing Music-Supported Rehabilitation (MSR) to Graded Repetitive Arm Supplementary Program (GRASP). Three assessment methods were used: magnetoencephalography (MEG), behavioral tests, and MRI scans. The document discusses the purpose and limitations of the assessments.
acute stroke for rehab physician - dr trilochan shrivastavamrinal joshi
1. The document discusses acute management and rehabilitation of stroke, providing information on types of strokes, risk factors, signs and symptoms, investigations, treatments, and rehabilitation approaches.
2. It covers diagnostic testing including imaging, medications, and interventional procedures for ischemic and hemorrhagic strokes.
3. Rehabilitation services are described including physical, occupational and speech therapy in various settings from inpatient to home-based care with the goal of improving functional abilities and outcomes for stroke patients.
1997 practice parameters for the indications for polysomnography and relate...alpha314
These clinical guidelines from the American Sleep Disorders Association provide recommendations for when polysomnography and related sleep studies are indicated in the diagnosis of various sleep disorders. The guidelines were developed by a task force that reviewed literature on the topic and consulted specialists. Key indications for polysomnography include diagnosing sleep-related breathing disorders, assessing positive airway pressure titration, and evaluating violent or injurious parasomnias. The guidelines also provide recommendations for when polysomnography may be indicated or is not routinely needed. The goal is to help ensure appropriate and cost-effective use of sleep testing procedures.
Fast Functional Magnetic Resonance Imaging (fast fMRI): uses MRI to measure nerve or brain activity directly
Uses MRI to detect the electromagnetic field that is generated by ionic currents (action potential)
This document summarizes a systematic review that compared the effectiveness of task-specific training using assistive devices to task-specific usual care for improving upper limb performance after stroke. Seventeen studies were included in the review. A meta-analysis found that in the subacute phase post-stroke, task-specific training using assistive devices was more effective at reducing upper limb impairment than task-specific usual care alone, based on Fugl-Meyer Assessment scores. However, in the chronic phase post-stroke, both interventions led to similar improvements in upper limb performance, with no significant differences found between the groups. The review concluded that both interventions can improve upper limb function after stroke but task-specific training using assistive devices may
This slide includes various neuroimaging methods. Firstly, brief backgrounds of positron emission tomography (PET), diffusion tensor MRI, voxel-based morphometry will be introduced. Secondly, a theoretical explanation of BOLD fMRI and preprocessing will be introduced.
http://skyeong.net
The value of pre and intra-operative adjuncts on the extent of resection of ...Dr Shahanur Rahman
Low-grade gliomas (LGGs):
LLG are diffuse hemispheric infiltrative,
WHO classification grades I and II and
account for 30% of all gliomas.
LGGs characterized by
continuous growth and progression to anaplastic transformation.
LGG surgery remains a challenge
these tumors are hard to differentiate from normal brain at surgery as they can infiltrate into eloquent tissue.
Neurosurgical adjuncts have been
developed and increasingly being used
to achieve maximal resection
with a minimal risk of postoperative
neurologic morbidity.
This document discusses the mirror neuron system and its role in neurorehabilitation. It begins by providing an overview of mirror neurons, their role in imitation and action understanding. It then discusses how the mirror neuron system can be used in neurorehabilitation approaches like motor imagery, mirror therapy, and action observation. While these mirror neuron-based interventions provide additional methods for motor training and recovery from stroke, there are also potential challenges to their use including damaged brain areas limiting activation and issues with patient fatigue or attention.
This document provides an overview of mirror therapy as a treatment approach to support upper extremity recovery after stroke. It discusses the theoretical foundations of mirror therapy, describing how visual feedback of movement can facilitate cortical reorganization. Several studies are summarized that demonstrate the effectiveness of mirror therapy for improving motor function, activities of daily living, and pain when used as an adjunct to traditional stroke rehabilitation. The document concludes with a demonstration of how mirror therapy is performed in a clinical setting.
The document provides an overview of various medical imaging techniques used to image the brain including CT, MRI, fMRI, PET, and SPECT. It describes each technique, how they work, what types of images they produce, and what they can be used to detect in the brain. CT uses X-rays to produce 2D images while MRI uses magnetic fields and radio waves to produce detailed 3D images without radiation. fMRI can show which parts of the brain are active during tasks by tracking blood flow and oxygen usage. PET and SPECT involve radioactive tracers to detect biochemical processes.
When Your Head Hurts and Your Memory Fails- Is It Your Lupus? discusses potential neurological manifestations of systemic lupus erythematosus (SLE), including headaches, seizures, strokes, and cognitive dysfunction. Diagnosis involves confirming SLE diagnosis, ruling out other causes, and using tools like MRI, EEG, and testing to evaluate specific symptoms. Treatment depends on symptoms but may include steroids, antimalarials, DMARDs, immunosuppressants, and targeting specific pathways implicated in SLE pathogenesis. Future treatment directions include developing biomarkers, increasing funding for trials, and leveraging improved understanding of disease mechanisms.
This document discusses oral health issues related to lupus and Sjogren's syndrome. It outlines that oral ulcers, dry mouth, and infections are common oral manifestations. Medications used to treat lupus and Sjogren's can also impact oral health. Proper dental care, saliva substitutes, and medications like pilocarpine or cevimelene can help manage dry mouth. Fungal infections like candida and viral infections like herpes simplex need to be treated with anti-fungal or anti-viral medications. Bisphosphonates used for osteoporosis can potentially cause osteonecrosis of the jaw, so dental exams are recommended before starting these therapies.
Lupus can affect many organs, including the kidneys, in up to 50% of patients. Lupus nephritis is an inflammation of the kidneys caused by lupus that can lead to scarring and fibrosis if not treated. A kidney biopsy is always indicated to determine the stage of kidney involvement, assess prognosis, and guide treatment decisions. Treatment involves controlling blood pressure and protein levels in the urine with medications, as well as targeted therapies like immunosuppressants depending on biopsy results. Prognosis depends on biopsy findings, with dialysis needed if renal function deteriorates significantly.
by Cono Grasso, MD
Jamaica Hospital Medical Center
Presented at the S.L.E. Lupus Foundation's "Get into the Loop!" New York City Lupus Education Series on October 6, 2010.
Systemic lupus erythematosus (SLE) can involve all layers of the heart, including the pericardium, myocardium, valves, and coronary arteries. Patients with SLE have a 4-8 fold increased risk of developing cardiovascular disease compared to the general population. Studies have found significantly higher rates of atherosclerosis in SLE patients compared to age-matched controls, even in younger patients and those without traditional risk factors. Aggressive treatment of modifiable risk factors such as dyslipidemia, hypertension, and smoking is important for reducing cardiovascular risk in SLE patients.
This document appears to be a transcript from a Cambridge English exam taken by Khấu Vĩnh Công in 2008. It consists of his name and email address repeated on multiple lines, suggesting it may be an incomplete or corrupted transcript without the actual test content. The document provides identifying information about an exam taken by Khấu Vĩnh Công in 2008 but does not include any test questions or responses.
The document discusses the history and development of artificial intelligence over the past 70 years. It outlines some of the key milestones in AI research from the early work in the 1950s to modern advances in machine learning using neural networks. While progress has been made, fully general human-level artificial intelligence remains an ongoing challenge that researchers are still working to achieve.
The document discusses the company's financial performance in the last quarter of 2022. Revenue was up 10% compared to the same period last year, driven primarily by growth in the technology and healthcare sectors. However, expenses also rose at a higher-than-expected rate due to inflation and supply chain issues, resulting in net income being down 5% year-over-year.
The document discusses the history and development of a new technology called blockchain. Blockchain first emerged with bitcoin, using cryptography to allow transactions to be securely recorded and verified in a decentralized database. It has now expanded beyond cryptocurrencies to include applications in areas like finance, law, and government where there is need for a secure and decentralized record of transactions and information.
This document discusses advanced MRI techniques for studying multiple sclerosis (MS). It describes how MRI has limitations in conventional modalities but advanced techniques like magnetization transfer imaging (MTR), diffusion tensor imaging (DTI), and measuring brain atrophy provide more sensitive assessments of MS pathology. MTR specifically shows sensitivity to demyelination and remyelination in MS lesions and predicts disability progression. However, further validation of these advanced techniques is still needed to fully characterize MS injury throughout the brain and spinal cord.
This review article discusses the use of magnetic resonance imaging (MRI) in diagnosing and monitoring multiple sclerosis (MS). MRI plays a key role in MS diagnosis by detecting lesions in the brain and spinal cord to demonstrate dissemination of the disease in space and time. Conventional MRI markers described include hyperintense lesions on T2-weighted, proton density, and fluid-attenuated inversion recovery sequences, which indicate demyelination and inflammation. Hypointense lesions on T1-weighted sequences ("black holes") correlate with axonal loss. Lesion number, location and volume provide information on prognosis and can predict disability and disease progression. Non-conventional MRI techniques discussed provide additional insights into MS pathology.
Fast Functional Magnetic Resonance Imaging (fast fMRI): uses MRI to measure nerve or brain activity directly
Uses MRI to detect the electromagnetic field that is generated by ionic currents (action potential)
This document summarizes a systematic review that compared the effectiveness of task-specific training using assistive devices to task-specific usual care for improving upper limb performance after stroke. Seventeen studies were included in the review. A meta-analysis found that in the subacute phase post-stroke, task-specific training using assistive devices was more effective at reducing upper limb impairment than task-specific usual care alone, based on Fugl-Meyer Assessment scores. However, in the chronic phase post-stroke, both interventions led to similar improvements in upper limb performance, with no significant differences found between the groups. The review concluded that both interventions can improve upper limb function after stroke but task-specific training using assistive devices may
This slide includes various neuroimaging methods. Firstly, brief backgrounds of positron emission tomography (PET), diffusion tensor MRI, voxel-based morphometry will be introduced. Secondly, a theoretical explanation of BOLD fMRI and preprocessing will be introduced.
http://skyeong.net
The value of pre and intra-operative adjuncts on the extent of resection of ...Dr Shahanur Rahman
Low-grade gliomas (LGGs):
LLG are diffuse hemispheric infiltrative,
WHO classification grades I and II and
account for 30% of all gliomas.
LGGs characterized by
continuous growth and progression to anaplastic transformation.
LGG surgery remains a challenge
these tumors are hard to differentiate from normal brain at surgery as they can infiltrate into eloquent tissue.
Neurosurgical adjuncts have been
developed and increasingly being used
to achieve maximal resection
with a minimal risk of postoperative
neurologic morbidity.
This document discusses the mirror neuron system and its role in neurorehabilitation. It begins by providing an overview of mirror neurons, their role in imitation and action understanding. It then discusses how the mirror neuron system can be used in neurorehabilitation approaches like motor imagery, mirror therapy, and action observation. While these mirror neuron-based interventions provide additional methods for motor training and recovery from stroke, there are also potential challenges to their use including damaged brain areas limiting activation and issues with patient fatigue or attention.
This document provides an overview of mirror therapy as a treatment approach to support upper extremity recovery after stroke. It discusses the theoretical foundations of mirror therapy, describing how visual feedback of movement can facilitate cortical reorganization. Several studies are summarized that demonstrate the effectiveness of mirror therapy for improving motor function, activities of daily living, and pain when used as an adjunct to traditional stroke rehabilitation. The document concludes with a demonstration of how mirror therapy is performed in a clinical setting.
The document provides an overview of various medical imaging techniques used to image the brain including CT, MRI, fMRI, PET, and SPECT. It describes each technique, how they work, what types of images they produce, and what they can be used to detect in the brain. CT uses X-rays to produce 2D images while MRI uses magnetic fields and radio waves to produce detailed 3D images without radiation. fMRI can show which parts of the brain are active during tasks by tracking blood flow and oxygen usage. PET and SPECT involve radioactive tracers to detect biochemical processes.
When Your Head Hurts and Your Memory Fails- Is It Your Lupus? discusses potential neurological manifestations of systemic lupus erythematosus (SLE), including headaches, seizures, strokes, and cognitive dysfunction. Diagnosis involves confirming SLE diagnosis, ruling out other causes, and using tools like MRI, EEG, and testing to evaluate specific symptoms. Treatment depends on symptoms but may include steroids, antimalarials, DMARDs, immunosuppressants, and targeting specific pathways implicated in SLE pathogenesis. Future treatment directions include developing biomarkers, increasing funding for trials, and leveraging improved understanding of disease mechanisms.
This document discusses oral health issues related to lupus and Sjogren's syndrome. It outlines that oral ulcers, dry mouth, and infections are common oral manifestations. Medications used to treat lupus and Sjogren's can also impact oral health. Proper dental care, saliva substitutes, and medications like pilocarpine or cevimelene can help manage dry mouth. Fungal infections like candida and viral infections like herpes simplex need to be treated with anti-fungal or anti-viral medications. Bisphosphonates used for osteoporosis can potentially cause osteonecrosis of the jaw, so dental exams are recommended before starting these therapies.
Lupus can affect many organs, including the kidneys, in up to 50% of patients. Lupus nephritis is an inflammation of the kidneys caused by lupus that can lead to scarring and fibrosis if not treated. A kidney biopsy is always indicated to determine the stage of kidney involvement, assess prognosis, and guide treatment decisions. Treatment involves controlling blood pressure and protein levels in the urine with medications, as well as targeted therapies like immunosuppressants depending on biopsy results. Prognosis depends on biopsy findings, with dialysis needed if renal function deteriorates significantly.
by Cono Grasso, MD
Jamaica Hospital Medical Center
Presented at the S.L.E. Lupus Foundation's "Get into the Loop!" New York City Lupus Education Series on October 6, 2010.
Systemic lupus erythematosus (SLE) can involve all layers of the heart, including the pericardium, myocardium, valves, and coronary arteries. Patients with SLE have a 4-8 fold increased risk of developing cardiovascular disease compared to the general population. Studies have found significantly higher rates of atherosclerosis in SLE patients compared to age-matched controls, even in younger patients and those without traditional risk factors. Aggressive treatment of modifiable risk factors such as dyslipidemia, hypertension, and smoking is important for reducing cardiovascular risk in SLE patients.
This document appears to be a transcript from a Cambridge English exam taken by Khấu Vĩnh Công in 2008. It consists of his name and email address repeated on multiple lines, suggesting it may be an incomplete or corrupted transcript without the actual test content. The document provides identifying information about an exam taken by Khấu Vĩnh Công in 2008 but does not include any test questions or responses.
The document discusses the history and development of artificial intelligence over the past 70 years. It outlines some of the key milestones in AI research from the early work in the 1950s to modern advances in machine learning using neural networks. While progress has been made, fully general human-level artificial intelligence remains an ongoing challenge that researchers are still working to achieve.
The document discusses the company's financial performance in the last quarter of 2022. Revenue was up 10% compared to the same period last year, driven primarily by growth in the technology and healthcare sectors. However, expenses also rose at a higher-than-expected rate due to inflation and supply chain issues, resulting in net income being down 5% year-over-year.
The document discusses the history and development of a new technology called blockchain. Blockchain first emerged with bitcoin, using cryptography to allow transactions to be securely recorded and verified in a decentralized database. It has now expanded beyond cryptocurrencies to include applications in areas like finance, law, and government where there is need for a secure and decentralized record of transactions and information.
This document discusses advanced MRI techniques for studying multiple sclerosis (MS). It describes how MRI has limitations in conventional modalities but advanced techniques like magnetization transfer imaging (MTR), diffusion tensor imaging (DTI), and measuring brain atrophy provide more sensitive assessments of MS pathology. MTR specifically shows sensitivity to demyelination and remyelination in MS lesions and predicts disability progression. However, further validation of these advanced techniques is still needed to fully characterize MS injury throughout the brain and spinal cord.
This review article discusses the use of magnetic resonance imaging (MRI) in diagnosing and monitoring multiple sclerosis (MS). MRI plays a key role in MS diagnosis by detecting lesions in the brain and spinal cord to demonstrate dissemination of the disease in space and time. Conventional MRI markers described include hyperintense lesions on T2-weighted, proton density, and fluid-attenuated inversion recovery sequences, which indicate demyelination and inflammation. Hypointense lesions on T1-weighted sequences ("black holes") correlate with axonal loss. Lesion number, location and volume provide information on prognosis and can predict disability and disease progression. Non-conventional MRI techniques discussed provide additional insights into MS pathology.
This document summarizes nuclear medicine imaging techniques for diagnosing dementia. It discusses how [18F]FDG PET has been used to detect changes in brain glucose metabolism associated with Alzheimer's disease (AD), often years before symptoms appear. More recently, PET imaging of amyloid-β plaques has provided a way to detect a key pathological feature of AD in living patients. The document reviews these nuclear medicine approaches and their potential to improve early detection and differential diagnosis of dementia.
This document provides an overview of multiple sclerosis (MS), including its characteristics, pathogenesis, clinical course, diagnosis using MRI, and current and emerging treatments. Key points:
- MS is a chronic autoimmune disease affecting the central nervous system, characterized by inflammation, demyelination and axonal loss from early stages. It mainly affects young adults aged 20-40, with higher prevalence in women.
- The clinical course involves both acute relapses and progressive disability. A "topographical model" represents the CNS in layers of increasing vulnerability and shows how disability evolves based on lesion location and the brain's residual reserve.
- MRI plays a critical role in diagnosis by demonstrating dissemination of lesions in
Clinical imaging and molecular biomarkers of drug resistant epilepsy.pptxPramod Krishnan
Clinical, imaging and molecular biomarkers in drug resistant epilepsy
1. Several clinical factors predict drug resistant epilepsy including early age of onset, frequent seizures, neurological deficits, and failure to respond to initial treatment.
2. Imaging biomarkers such as abnormalities on MRI, focal hypometabolism on PET, and changes in diffusion can help identify potential epileptogenic lesions.
3. Molecular biomarkers reflect underlying pathological processes like abnormal excitatory/inhibitory neurotransmission, neuroinflammation, and changes in gene and protein expression that may contribute to drug resistance. Combining biomarkers provides a more precise approach to managing drug resistant epilepsy.
This document provides an overview of neuroimaging techniques used in psychiatry. It discusses various structural and functional neuroimaging methods including CT, MRI, fMRI, SPECT, PET, DTI, and MRS. CT and MRI provide structural images while fMRI, SPECT, PET, and MRS assess brain function by measuring activity, blood flow, and metabolite levels. Neuroimaging has improved understanding of psychiatric conditions and informed research on the pathophysiology of disorders.
This document provides an overview of nerve compression syndromes, including their pathophysiology, clinical presentation, assessment, and management. It discusses how nerve compression can lead to neuropathic pain through mechanisms like ischemia, inflammation, and central nervous system changes. Common compression neuropathies like carpal tunnel syndrome and sciatica are mentioned. The document emphasizes that entrapment neuropathies have complex presentations that do not always clearly fit the grading criteria for neuropathic pain. A thorough clinical assessment including history, exam, and provocation tests is important for diagnosis.
1) The document discusses imaging of cerebral ischemia from acute stroke to chronic disorders. Imaging provides valuable information about disease progression, diagnosis, treatment selection and monitoring over time.
2) Several imaging modalities such as CT, MRI, CTA and CTP can be used to evaluate brain parenchyma integrity, vascular disease severity, and changes in tissue metabolism and perfusion over the acute, subacute and chronic phases of ischemia.
3) Choosing the appropriate imaging modality depends on the specific clinical question and can help guide management decisions by providing insight into disease mechanisms and monitoring progression.
Chronic inflammatory demyelinating polyradiculoneuropathy (CIDP) is the most common chronic inflammatory neuropathy. CIDP is diagnosed according to the European Federation of Neurological Societies/Peripheral Nerve Society (EFNS/PNS) criteria
https://www.youtube.com/watch?v=AYEhL1LdONY
PET/MR imaging in neurodegenerative diseasesWalid Rezk
The document discusses the current and future potential applications of PET/MR imaging in neurodegenerative diseases. PET/MR combines the molecular imaging capabilities of PET with the high spatial resolution of MRI. It allows simultaneous acquisition of PET and MRI data. Current applications include detection of amyloid plaques and dopamine deficits. Emerging tracers may image tau and alpha-synuclein. Novel MRI techniques like diffusion tensor imaging and arterial spin labeling also show promise. Combined PET/MR could become a routine first-line tool for diagnosis and may aid basic research into neurodegeneration.
- Acute disseminated encephalomyelitis (ADEM) is a monophasic, postinfectious or postvaccine acute inflammatory demyelinating disorder of the central nervous system.
- The first-line treatment for ADEM is high-dose intravenous methylprednisolone for 3-5 days. If corticosteroids fail, plasma exchange or intravenous immunoglobulin can be used as second-line treatments.
- ADEM usually follows a monophasic course, but can occasionally be multiphasic or recurrent. Relapses are usually treated similarly to the initial presentation.
references:
Phases and Phenotypes of Multiple Sclerosis By Orhun H. Kantarci, MD.
Diagnosis of Multiple Sclerosis By Jiwon Oh, MD, PhD, FRCPC
Nature Reviews | Disease Primers
Multiple sclerosis Massimo Filippi1,2*, Amit Bar- Or3, Fredrik Piehl4,5,6, Paolo Preziosa1,2, Alessandra Solari7, Sandra Vukusic8 and Maria A. Rocca1,2
This document provides an overview of magnetic resonance imaging (MRI) of the brain, including basic principles, MRI sequences, interpretation, and clinical correlation. It discusses normal brain anatomy as seen on MRI and provides labeled images. Common MRI protocols for various neurological conditions such as brain tumors, stroke, and infections are outlined. The value of clinical history and MRI findings for diagnosis is emphasized. An interactive case discussion session is included to demonstrate clinical correlations.
Neurosarcoidosis is a rare condition where sarcoidosis affects the nervous system. It can be difficult to diagnose as it often presents with non-specific neurological symptoms. Diagnosis requires a combination of CSF analysis, MRI imaging showing characteristic abnormalities, and biopsy evidence of granulomas. A multidisciplinary team approach is needed to manage this complex condition.
This document provides an overview of brain stimulation strategies for obsessive-compulsive disorder (OCD). It begins with definitions and classifications of OCD according to DSM-5 and ICD-11 criteria. It then discusses the neurobiology of OCD including abnormalities in frontostriatal circuits. Treatment modalities covered include pharmacotherapy with SSRIs, psychotherapy such as exposure therapy, and brain stimulation methods like transcranial magnetic stimulation and deep brain stimulation. Mechanisms of action and comparisons between brain stimulation and pharmacotherapy are also presented. The document provides context on neuromodulation therapies and their role in treating psychiatric disorders through targeted brain stimulation.
Neurology 2nd investigation of neurological diseaseRamiAboali
This document discusses various neurological investigations and presenting problems. It provides details on neuroimaging techniques like CT, MRI, EEG and lumbar puncture. It also describes nerve conduction studies and evoked potentials. Common presenting problems covered include syncope, coma, and alterations in behavior like delirium and dementia. Causes, diagnosis, and management are discussed for syncope and coma. The document is a reference for neurology that outlines different testing and clinical presentations.
The document discusses a study of 11 patients with surgically confirmed degenerative dorsal disc herniation. Clinical exams and tests found higher rates of vascular risk factors and increased blood viscosity in these patients compared to controls. MRI and CT myelography showed partially or heavily calcified disc herniations in the lower dorsal spine. The clinical presentation was characterized by a mainly motor myelopathy with remissions and exacerbations. The findings help explain the pathogenesis and clinical presentation of myelopathy from degenerative dorsal disc disease.
8 Surprising Reasons To Meditate 40 Minutes A Day That Can Change Your Life.pptxHolistified Wellness
We’re talking about Vedic Meditation, a form of meditation that has been around for at least 5,000 years. Back then, the people who lived in the Indus Valley, now known as India and Pakistan, practised meditation as a fundamental part of daily life. This knowledge that has given us yoga and Ayurveda, was known as Veda, hence the name Vedic. And though there are some written records, the practice has been passed down verbally from generation to generation.
Basavarajeeyam is a Sreshta Sangraha grantha (Compiled book ), written by Neelkanta kotturu Basavaraja Virachita. It contains 25 Prakaranas, First 24 Chapters related to Rogas& 25th to Rasadravyas.
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
Integrating Ayurveda into Parkinson’s Management: A Holistic ApproachAyurveda ForAll
Explore the benefits of combining Ayurveda with conventional Parkinson's treatments. Learn how a holistic approach can manage symptoms, enhance well-being, and balance body energies. Discover the steps to safely integrate Ayurvedic practices into your Parkinson’s care plan, including expert guidance on diet, herbal remedies, and lifestyle modifications.
Osteoporosis - Definition , Evaluation and Management .pdfJim Jacob Roy
Osteoporosis is an increasing cause of morbidity among the elderly.
In this document , a brief outline of osteoporosis is given , including the risk factors of osteoporosis fractures , the indications for testing bone mineral density and the management of osteoporosis
Local Advanced Lung Cancer: Artificial Intelligence, Synergetics, Complex Sys...Oleg Kshivets
Overall life span (LS) was 1671.7±1721.6 days and cumulative 5YS reached 62.4%, 10 years – 50.4%, 20 years – 44.6%. 94 LCP lived more than 5 years without cancer (LS=2958.6±1723.6 days), 22 – more than 10 years (LS=5571±1841.8 days). 67 LCP died because of LC (LS=471.9±344 days). AT significantly improved 5YS (68% vs. 53.7%) (P=0.028 by log-rank test). Cox modeling displayed that 5YS of LCP significantly depended on: N0-N12, T3-4, blood cell circuit, cell ratio factors (ratio between cancer cells-CC and blood cells subpopulations), LC cell dynamics, recalcification time, heparin tolerance, prothrombin index, protein, AT, procedure type (P=0.000-0.031). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and N0-12 (rank=1), thrombocytes/CC (rank=2), segmented neutrophils/CC (3), eosinophils/CC (4), erythrocytes/CC (5), healthy cells/CC (6), lymphocytes/CC (7), stick neutrophils/CC (8), leucocytes/CC (9), monocytes/CC (10). Correct prediction of 5YS was 100% by neural networks computing (error=0.000; area under ROC curve=1.0).
Here is the updated list of Top Best Ayurvedic medicine for Gas and Indigestion and those are Gas-O-Go Syp for Dyspepsia | Lavizyme Syrup for Acidity | Yumzyme Hepatoprotective Capsules etc
ABDOMINAL TRAUMA in pediatrics part one.drhasanrajab
Abdominal trauma in pediatrics refers to injuries or damage to the abdominal organs in children. It can occur due to various causes such as falls, motor vehicle accidents, sports-related injuries, and physical abuse. Children are more vulnerable to abdominal trauma due to their unique anatomical and physiological characteristics. Signs and symptoms include abdominal pain, tenderness, distension, vomiting, and signs of shock. Diagnosis involves physical examination, imaging studies, and laboratory tests. Management depends on the severity and may involve conservative treatment or surgical intervention. Prevention is crucial in reducing the incidence of abdominal trauma in children.
Histololgy of Female Reproductive System.pptxAyeshaZaid1
Dive into an in-depth exploration of the histological structure of female reproductive system with this comprehensive lecture. Presented by Dr. Ayesha Irfan, Assistant Professor of Anatomy, this presentation covers the Gross anatomy and functional histology of the female reproductive organs. Ideal for students, educators, and anyone interested in medical science, this lecture provides clear explanations, detailed diagrams, and valuable insights into female reproductive system. Enhance your knowledge and understanding of this essential aspect of human biology.
Muktapishti is a traditional Ayurvedic preparation made from Shoditha Mukta (Purified Pearl), is believed to help regulate thyroid function and reduce symptoms of hyperthyroidism due to its cooling and balancing properties. Clinical evidence on its efficacy remains limited, necessitating further research to validate its therapeutic benefits.
Thyroid Gland- Gross Anatomy by Dr. Rabia Inam Gandapore.pptx
Imagenes en lupus
1. REVIEWS
382
IMAJ • VOL 15 • july 2013
Systemic lupus erythematosus (SLE) is a complex autoimmune
disorder involving multiple organs. One of the main sites
of SLE morbidity is the central nervous system (CNS), spe-
cifically the brain. In this article we review several imaging
modalities used for CNS examination in SLE patients. These
modalities are categorized as morphological and functional.
Special attention is given to magnetic resonance imaging
(MRI) and its specific sequences such as diffusion-weighted
imaging (DWI), diffuse tensor imaging (DTI) and magnetic
resonance spectroscopy (MRS). These modalities allow us
to better understand CNS involvement in SLE patients, its
pathophysiology and consequences.
IMAJ 2013; 15: 382–386
systemic lupus erythematosus (SLE), neuropsychiatric
systemic lupus erythematosus (NPSLE), magnetic resonance
imaging (MRI), diffusion-weighted imaging (DWI), diffuse
tensor imaging (DTI), computed tomography (CT)
Central Nervous System Involvement in Systemic Lupus
Erythematosus: An Imaging Challenge
Gal Yaniv MD PhD1, Gilad Twig MD PhD2,3, Oshry Mozes MD1, Gahl Greenberg MD1, Chen Hoffmann MD1
and Yehuda Shoenfeld MD FRCP3
1
Department of Diagnostic Imaging, 2
Department of Internal Medicine B and 3
Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, Tel Hashomer, Israel
Abstract:
Key words:
C
entral nervous system involvement is a common and dan-
gerous manifestation of systemic lupus erythematosus.
Various studies have shown a variable prevalence of radiological
CNS1
involvement in patients with SLE2
, ranging from 15% to
90%. A further differentiation of CNS involvement in the course
of SLE is the clinical entity neuropsychiatric systemic lupus ery-
thematosus. In 1999 a multidisciplinary committee appointed
by the American College of Rheumatology assembled 19 case
definitions of central, peripheral and autonomic manifestations
of the nervous system in patients with SLE that excluded other
causes. Among the latter are sei-
zures, mood disorders, headache,
aseptic meningitis and others [1].
It is estimated that up to 90%
of patients with SLE will suffer
eventually from NPSLE3
[2]. The most common manifesta-
tions are headache (24%), cerebrovascular disease (17.6%) and
CNS = central nervous system
SLE = systemic lupus erythematosus
NPSLE = neuropsychiatric systemic lupus erythematosus
mood disorders (16.7%) [3,4]. While a clinical examination of
the nervous system combined with psychological assessment
are still the cornerstones of NPSLE diagnosis, laboratory tests,
cerebrospinal fluid tests, electroencephalography and imaging
are also used to support the diagnosis [5]. Different imaging
modalities, both morphological and functional, can be used
for evaluating NPSLE and have become an important tool in
its diagnosis [6-10].
This review article is intended to provide clinicians who
treat SLE patients with a broad view of current imaging modal-
ities and techniques, as well as the most prevalent pathologi-
cal findings encountered. Also, the most recent data on each
modality are reviewed. Among the morphological modalities
used are multi-detector computed tomography, magnetic
resonance imaging, diffuse tensor imaging, and magnetic reso-
nance spectroscopy. Functional modalities include positron-
emission tomography, single positron-emission computed
tomography, and functional MRI. The focus of this review is
MRI since it is the gold standard for CNS evaluation in SLE
patients today [Table 1]. Nonetheless, the other modalities are
presented as well, describing both the method and the patho-
logical findings of CNS involvement in SLE patients [Table 2].
FUNCTIONAL MODALITIES
SPECT
Single positron-emission computed tomography provides a
tomographic reconstruction for the imaging of single photons
emitted by radiolabeled tracers. Following intravenous admin-
istration of these tracers, regional blood flow and neuronal
integrity are measured, making it possible to diagnosis areas
with normal flow and hypoperfu-
sion [9]. In several studies, abnor-
mal SPECT4
scans, mainly at the
parietal, frontal and temporal
lobes, were correlated with overall
disease activity and damage [5,11]. It has also been correlated in
patients with antiphospholipid syndrome [12]. The most com-
monly observed abnormalities detected by SPECT are diffuse,
SPECT = single-positron emission computed tomography
Current imaging modalities
and techniques enable not only
morphological imaging of the patient’s
brain but a functional view as well
2. REVIEWS
383
IMAJ • VOL 15 • july 2013
focal or multifocal areas of decreased uptake corresponding to
hypoperfusion [13].
PET
The PET5
exam measures the brain glucose uptake and oxygen
consumption by using 2-18G-fluoro-2-deoxyglucose. In NPSLE,
the most common areas affected are the parieto-occipital and
parietal regions, demonstrating hypometabolism. It has been
reported that successful treatment of NPSLE eliminated func-
tional abnormalities seen before treatment in several cases [14].
fMRI
Functional MRI is based on the blood-oxygen-level depen-
dence (BOLD) as an MRI contrast of blood deoxyhemoglobin.
Changes in BOLD6
signal are well correlated with changes in
blood flow and are therefore able to demonstrate functionally
active areas in the brain. Several studies have shown abnormal
increased regional brain activity in NPSLE patients compared to
controls [15] during memory tasks and was correlated to disease
duration, supporting the hypothesis that the pathological effect
of SLE on the brain is cumulative [16].
MORPHOLOGICAL MODALITIES
MDCT
Multiple-detector computed tomography provides cross-sec-
tional images by means of variable absorption of X-ray radia-
tion by different tissues. MDCT7
is used mainly in emergency
settings to exclude acute infarct, hemorrhage, abscess, edema,
or meningitis. In addition, MDCT has low specificity and
sensitivity to NPSLE. Among the chronic findings relevant
to NPSLE are cerebral atrophy and calcifications.
MRI
Magnetic resonance imaging is considered the gold standard
for NPSLE imaging today. It uses the magnetic characteristics
of hydrogen nuclei to obtain images of tissues based on their
different proton compositions. There are several sequences that
help to delineate different pathologies. These include T1, T2,
FLAIR, DWI and PWI (perfusion weighted images) [Figure 1,
Table 1]. T2-weighted and fluid-attenuated inversion recovery
(FLAIR) imaging enable visualization of pathologies such as
fluid and edema as a bright signal, as they are sensitive to fluid
content [17-19]. T1-weighted imaging, which is a fat-sensitive
sequence, is usually normal in patients with NPSLE. The most
common MRI8
abnormalities are small subcortical hyperin-
tense lesions, infarcts and brain atrophy [5,20-23] and are more
common in patients with NPSLE than in those without.
PET = positron-emission tomography
BOLD = blood-oxygen-level dependence
MDCT = multi-detector computed tomography
MRI = magnetic resonance imaging
Morphological changes, as shown by MRI, can be caused
by the disease itself (primary NPSLE) or is due to disease com-
plications or to treatment [9]. It is now an accepted notion that
a morphological imaging modality (such as MRI) cannot dif-
ferentiate between acute or chronic lesions [9]. However, recent
work by Katsumata et al. [10] has shown in a prospective study
Sequence Description Common findings Refs
T1 Fat-sensitive sequence Brain atrophy
T2 Fluid-sensitive sequence Subcortical hyperintense lesions, infarcts,
atrophy
[16-18]
FLAIR Fluid-sensitive sequence Subcortical hyperintense lesions, infarcts,
atrophy
[16-18]
DWI Shows inflammatory
changes
Differentiates from
ischemic lesions
Decreased intensity on inflammatory
changes
Differentiates cytotoxic (high) and
vasogenic (low) edema
[30-32]
ADC Same as DWI
Removes T2 shine-
through artifacts
Increased intensity on inflammatory changes
Differentiates cytotoxic (low) and vasogenic
(high) edema
[30-32]
DTI Measures axonal integrity,
which is disrupted in
NPSLE patients
Pathological signal from white matter of
corpus callosum, left arm of forceps major
and left anterior corona radiata
[33-35]
MRS Measures disease activity Reduced NAA levels (not a specific finding)
Elevated choline levels
[3,7,12,
31,36-39]
FLAIR = fluid-attenuated inversion recovery, DWI = diffusion-weighted imaging, ADC = apparent
coefficient of diffusion, DTI = diffuse tensor imaging, MRS = magnetic resonance spectroscopy
Table 1. MRI sequences used in CNS imaging
Figure 1. MRI scan, axial plane, in a 24 year old woman with NPSLE. [A] T1-weighted
image: arrow indicates hypointense lesion. [B,C] T2-weighted and FLAIR images:
arrow indicates subcortical hyperintense lesion. [D,E] DWI image and ADC map:
arrow indicates restricted diffusion in the lesion. [F] T1 + gadolinium images: the
lesion enhanced after gadolinium administration
3. REVIEWS
384
IMAJ • VOL 15 • july 2013
DWI
Diffusion-weighted imaging measures the diffusion of water
molecules in the brain. In normal brain tissue, water molecules
flow along white matter tracts. Inflammatory changes, which
cause disruption of white matter tracts, will result in an eleva-
tion of water diffusion, measured by apparent coefficient of
diffusion, which will be higher. However, an acute ischemic
insult will result in an initial reduction of diffusion, which
will show a higher DWI9
signal. A few studies have shown an
increased diffusion (higher ADC10
signal, lower DWI signal)
in patients with NPSLE [31,32]. This finding indicates a loss
of tissue integrity in NPSLE patients in both gray and white
matter [33]. Moreover, because of its ability to discriminate
between cytotoxic (high DWI) and vasogenic (low DWI)
edema, it can discriminate between inflammatory and isch-
emic lesions in SLE patients.
• DTI
Diffusion tensor imaging quantifies the exchange of protons
between those bound in macromolecules, such as myelin com-
posites, and free water. Compared with a more isotropic move-
ment of water in gray matter, water diffusion in white matter
moves anisotropically. DTI11
enables tracking of the diffusion of
water in the brain by measuring fractional anisotropy and mean
diffusivity. FA12
measures overall axonal integrity, while MD1 3
measures the average molecular motion, independent of tissue
boundaries. A previous study by Jung et al. [34] showed that
while MD and FA were not signifi-
cantly different between patients with
SLE without NPSLE and healthy con-
trols, in acute NPSLE patients numer-
ous FA and MD changes were found,
reflecting diffuse white matter abnormalities as compared to
both healthy controls and SLE patients without NPSLE. Among
the explanations given for the changes are immune-mediated
vascular or neuronal injury, therapy-induced CNS changes,
macro-micro embolisms causing infarcts, or small hemor-
rhages and edema. Interestingly, the DTI pathological areas
did not correlate with common
pathological areas shown by other
sequences. These studies showed
that a specific pathological signal
from the white matter of corpus cal-
losum, left arm of the forceps major
and left anterior corona radiata correlates with acute NPSLE, as
shown earlier [35,36].
DWI = diffusion-weighted imaging
ADC = apparent coefficient of diffusion
DTI = diffusion tensor imaging
FA = fractional anisotropy
MD = mean diffusivity
that large pathological signals (≥ 10 mm) occur only in NPSLE
patients, while lesions smaller than 10 mm occur in both NPSLE
and non-NPSLE patients. Moreover,
chronological changes in the large
pathological areas showed correla-
tion with the clinical conditions and
even partial reversibility in NPSLE
patients, while smaller areas did not [6,10,19,24-26]. The exact
pathophysiological mechanism reflected by the large pathologi-
cal signals has not yet been determined. Among the differential
diagnoses are gray matter lesions, edema, and new infarcts.
Autoantibodies theoretically contribute to neuronal dys-
function by various mechanisms such as reaction with endo-
thelial, glial or neuronal cells. These
antibodies reach the brain tissue
because of an altered blood-brain
barrier caused by autoantibodies or
immune complexes [5].
The small (< 10 mm) subcorti-
cal hyperintense lesions were also shown not to correlate with
the immunoserological status of patients, especially regarding
lupus anticoagulant and anticardiolipin antibodies. However,
anti-lupus anticoagulant antibodies were shown to correlate
with multiple cerebral ischemic lesions or infarcts > 10 mm
[27-29]. Other antibodies such as anti-TUB, anti-PSYC (lac-
tosylsphingosine) and anti-SULF did not show any correlation
with abnormal imaging studies [30].
In the future a complete morphological
and functional imaging profile will be
combined with clinical data to create
better treatment and an improved
prognosis for SLE patients
Differentiation of acute from chronic
NPSLE in modalities such as DTI
and MRS and fMRI is becoming
increasingly accurate
SPECT = single-positron emission tomography, PET = positron-emission tomography, MRI =
magnetic resonance imaging, fMRI = functional MRI, MDCT = multi-detector computed tomography
Modality Pros Cons Indications
Common
findings Refs
SPECT Measures
tissue
function
Very low
resolution
Radiation
exposure
Disease activity
Tissue damage
Area of
hypoperfusion
[7,9 10,
11,12]
PET Measures
metabolic
activity
Low resolution
Radiation
exposure
Functional/
metabolic
changes
Hypometabolic
areas
[13]
fMRI See MRI Special skills
needed
Functional
changes
Abnormally
increased
regional brain
activity
[14,15]
MDCT High
availability
Provides
information
on other
brain
pathologies
Low sensitivity
and specificity
Rules out
acute infarct,
hemorrhage,
abscess, edema
Cerebral
atrophy,
calcifications
MRI No radiation
High
resolution
images
Cannot
differentiate
between acute
and chronic
lesions
Numerous tests
Parenchymal
damage
Small
subcortical
hyperintense
lesions,
infarcts, brain
atrophy
[3,4,7,8,
10,12,
16-40]
Table 2. Neuro-imaging modalities in SLE
4. REVIEWS
385
IMAJ • VOL 15 • july 2013
of these modalities may have a huge impact on the patient’s
treatment, since differentiating between the direct effects of
the disease or the treatment effect on the brain is critical. One
can assume that in the future a complete morphological and
functional imaging profile will be combined with the clinical
data to create better treatment and an improved prognosis for
SLE patients.
Corresponding author:
Dr. G. Yaniv
Dept. of Diagnostic Imaging, Sheba Medical Center, Tel Hashomer 52621, Israel
Phone: (972-3) 530-2530
Fax: (972-3) 535-7315
email: Gal.Yaniv@sheba.health.gov.il, mdgalyaniv13@gmail.com
References
1. The American College of Rheumatology nomenclature and case definitions
for neuropsychiatric lupus syndromes. Arthritis Rheum 1999; 42 (4): 599-608.
2. Hanly JG, Harrison MJ. Management of neuropsychiatric lupus. Best Pract
Res Clin Rheumatol 2005; 19 (5): 799-821.
3. Peterson PL, Axford JS, Isenberg D. Imaging in CNS lupus. Best Pract Res
Clin Rheumatol 2005; 19 (5): 727-39.
4. Borchers AT, Aoki CA, Naguwa SM, Keen CL, Shoenfeld Y, Gershwin ME.
Neuropsychiatric features of systemic lupus erythematosus. Autoimmun Rev
2005; 4 (6): 329-44.
5. Sanna G, Piga M, Terryberry JW, et al. Central nervous system involvement
in systemic lupus erythematosus: cerebral imaging and serological profile in
patients with and without overt neuropsychiatric manifestations. Lupus 2000;
9 (8): 573-83.
6. Sibbitt WL Jr, Sibbitt RR, Brooks WM. Neuroimaging in neuropsychiatric
systemic lupus erythematosus. Arthritis Rheum 1999; 42 (10): 2026-38.
7. Huizinga TW, Steens SC, van Buchem MA. Imaging modalities in central
nervous system systemic lupus erythematosus. Curr Opin Rheumatol 2001; 13
(5): 383-8.
8. Appenzeller S, Pike GB, Clarke AE. Magnetic resonance imaging in the evaluation
of central nervous system manifestations in systemic lupus erythematosus. Clin
Rev Allergy Immunol 2008; 34 (3): 361-6.
9. Castellino G, Govoni M, Giacuzzo S, Trotta F. Optimizing clinical monitoring of
central nervous system involvement in SLE. Autoimmun Rev 2008; 7 (4): 297-304.
10. Katsumata Y, Harigai M, Kawaguchi Y, et al. Diagnostic reliability of magnetic
resonance imaging for central nervous system syndromes in systemic lupus
erythematosus: a prospective cohort study. BMC Musculoskelet Disord 2010; 11: 13.
11. Lopez-Longo FJ, Carol N, Almoguera MI, et al. Cerebral hypoperfusion
detected by SPECT in patients with systemic lupus erythematosus is related
to clinical activity and cumulative tissue damage. Lupus 2003; 12 (11): 813-19.
12. Sun SS, Liu FY, Tsai JJ, Yen RF, Kao CH, Huang WS. Using 99mTc HMPAO
brain SPECT to evaluate the effects of anticoagulant therapy on regional cerebral
blood flow in primary antiphospholipid antibody syndrome patients with brain
involvement – a preliminary report. Rheumatol Int 2003; 23 (6): 301-4.
13. Colamussi P, Giganti M, Cittanti C, et al. Brain single-photon emission tomography
with 99mTc-HMPAO in neuropsychiatric systemic lupus erythematosus: relations
with EEG and MRI findings and clinical manifestations. Eur J Nucl Med 1995; 22
(1): 17-24.
14. Weiner SM, Otte A, Schumacher M, et al. Alterations of cerebral glucose
metabolism indicate progress to severe morphological brain lesions in
neuropsychiatric systemic lupus erythematosus. Lupus 2000; 9 (5): 386-9.
15. Fitzgibbon BM, Fairhall SL, Kirk IJ, et al. Functional MRI in NPSLE patients
reveals increased parietal and frontal brain activation during a working memory
task compared with controls. Rheumatology (Oxford) 2008; 47 (1): 50-3.
16. Mackay M, Bussa MP, Aranow C, et al. Differences in regional brain activation
patterns assessed by functional magnetic resonance imaging in patients with
systemic lupus erythematosus stratified by disease duration. Mol Med 2011;
17 (11-12): 1349-56.
• MRS
Also known as nuclear magnetic resonance spectroscopy, this
technique allows a quantitative assessment of several metabo-
lites in the brain tissue. Most of the studies are conducted
by using 1H (proton) MRS14
. Some studies used phosphorus
magnetic resonance, usually for measurements of high energy
molecule content in muscles. Different molecules can be dis-
tinguished by their frequency, and a quantitative assessment
is achieved at each frequency. The most common molecules
measured in the brain tissue are N-acetyl aspartate, a neuronal
marker found exclusively in neurons; choline, a marker of cell
membrane metabolism that can reflect inflammation or demy-
elination; creatine, which is involved in phosphate transport
system and found abundantly in glial and neuronal cells and is
usually used as a reference; and myoinositol, which is found in
glial tissue [3,9]. All these metabolites have been studied in SLE
patients [37,38]. MRS profiles have been shown to be changed
in NPSLE patients, although they are not specific for NPSLE
patients [13]. It has been shown that not only is NAA15
reduced
in CNS lesions of SLE patients, it is reduced in normal-looking
brain tissue as well [9]. NAA changes are more profound in
NPSLE patients than in SLE patients without neuropsychiatric
manifestations. This change can be permanent, which implies
neuronal death or transitory damage to the cells that may cor-
relate with overall disease activity [9,39]. A decrease in NAA
was noted in NPSLE patients with seizures, psychosis, confu-
sional state and cognitive dysfunction [3,37,40]. However, it
is important to recognize that a reduction in NAA levels can
occur in other brain pathologies as well, such as Alzheimer’s
disease, multiple sclerosis and even sleep apnea [3].
Choline levels were shown to be elevated in NPSLE patients,
and its levels correlated with disease activity and cognitive
state [32]. To date, MRS is not considered a diagnostic tool in
NPSLE diagnosis but should be part of disease management
and follow-up as it can quantify organic brain injury and help
characterize the type of injury. It is possible that in the future,
automated metabolic profiling could differentiate between
acute and chronic NPSLE.
SUMMARY
Imaging modalities and techniques have advanced tremen-
dously in the last decade. They enable not only a morphologi-
cal imaging of the patient’s brain, but a functional view as well.
The most dramatic change occurred in the MRI field, with
modalities such as DWI, DTI, fMRI and MRS, which allow
us to better understand CNS involvement in SLE patients, its
pathophysiology and consequences. There is initial informa-
tion regarding differentiation of acute from chronic NPSLE
in modalities such as DTI and MRS fMRI. Moreover, some
MRS = magnetic resonance spectroscopy
NAA = N-acetyl aspartate
5. REVIEWS
386
IMAJ • VOL 15 • july 2013
17. Baum KA, Hopf U, Nehrig C, Stover M, Schorner W. Systemic lupus
erythematosus: neuropsychiatric signs and symptoms related to cerebral MRI
findings. Clin Neurol Neurosurg 1993; 95 (1): 29-34.
18. McCune WJ, MacGuire A, Aisen A, Gebarski S. Identification of brain lesions
in neuropsychiatric systemic lupus erythematosus by magnetic resonance
scanning. Arthritis Rheum 1988; 31 (2): 159-66.
19. Sibbitt WL, Jr., Sibbitt RR, Griffey RH, Eckel C, Bankhurst AD. Magnetic
resonance and computed tomographic imaging in the evaluation of acute
neuropsychiatric disease in systemic lupus erythematosus. Ann Rheum Dis
1989; 48 (12): 1014-22.
20. CauliA,MontaldoC,PeltzMT,etal.Abnormalitiesofmagneticresonanceimaging
of the central nervous system in patients with systemic lupus erythematosus
correlate with disease severity. Clin Rheumatol 1994; 13 (4): 615-18.
21. Gonzalez-Crespo MR, Blanco FJ, Ramos A, et al. Magnetic resonance imaging
of the brain in systemic lupus erythematosus. Br J Rheumatol 1995; 34 (11):
1055-60.
22. Hachulla E, Michon-Pasturel U, Leys D, et al. Cerebral magnetic resonance
imaging in patients with or without antiphospholipid antibodies. Lupus 1998;
7 (2): 124-31.
23. Jacobs L, Kinkel PR, Costello PB, Alukal MK, Kinkel WR, Green FA. Central
nervous system lupus erythematosus: the value of magnetic resonance
imaging. J Rheumatol 1988; 15 (4): 601-6.
24. Jennings JE, Sundgren PC, Attwood J, McCune J, Maly P. Value of MRI of
the brain in patients with systemic lupus erythematosus and neurologic
disturbance. Neuroradiology 2004; 46 (1): 15-21.
25. Karassa FB, Ioannidis JP, Boki KA, et al. Predictors of clinical outcome and
radiologic progression in patients with neuropsychiatric manifestations of
systemic lupus erythematosus. Am J Med 2000; 109 (8): 628-34.
26. Graham JW, Jan W. MRI and the brain in systemic lupus erythematosus. Lupus
2003; 12 (12): 891-6.
27. Csepany T, Bereczki D, Kollar J, Sikula J, Kiss E, Csiba L. MRI findings in
central nervous system systemic lupus erythematosus are associated with
immunoserological parameters and hypertension. J Neurol 2003; 250 (11): 1348-54.
28. Zandman-Goddard G, Chapman J, Shoenfeld Y. Autoantibodies involved in
neuropsychiatric SLE and antiphospholipid syndrome. Semin Arthritis Rheum
2007; 36 (5): 297-315.
29. Kumral E, Evyapan D, Keser G, et al. Detection of microembolic signals in patients
with neuropsychiatric lupus erythematosus. Eur Neurol 2002; 47 (3): 131-5.
30. Sanna G, D’Cruz D, Cuadrado MJ. Cerebral manifestations in the anti-
phospholipid (Hughes) syndrome. Rheum Dis Clin North Am 2006; 32 (3): 465-90.
31. Bosma GP, Huizinga TW, Mooijaart SP, Van Buchem MA. Abnormal brain
diffusivity in patients with neuropsychiatric systemic lupus erythematosus.
AJNR Am J Neuroradiol 2003; 24 (5): 850-4.
32. Axford JS, Howe FA, Heron C, Griffiths JR. Sensitivity of quantitative (1)
H magnetic resonance spectroscopy of the brain in detecting early neuronal
damage in systemic lupus erythematosus. Ann Rheum Dis 2001; 60 (2): 106-11.
33. Welsh RC, Rahbar H, Foerster B, Thurnher M, Sundgren PC. Brain diffusivity
in patients with neuropsychiatric systemic lupus erythematosus with new
acute neurological symptoms. J Magn Reson Imaging 2007; 26 (3): 541-51.
34. Jung RE, Caprihan A, Chavez RS, et al. Diffusion tensor imaging in
neuropsychiatric systemic lupus erythematosus. BMC Neurol 2010; 10: 65.
35. Zhang L, Harrison M, Heier LA, et al. Diffusion changes in patients with
systemic lupus erythematosus. Magn Reson Imaging 2007; 25 (3): 399-405.
36. Hughes M, Sundgren PC, Fan X, et al. Diffusion tensor imaging in patients with
acute onset of neuropsychiatric systemic lupus erythematosus: a prospective
study of apparent diffusion coefficient, fractional anisotropy values, and
eigenvalues in different regions of the brain. Acta Radiol 2007; 48 (2): 213-22.
37. Friedman SD, Stidley CA, Brooks WM, Hart BL, Sibbitt WL Jr. Brain
injury and neurometabolic abnormalities in systemic lupus erythematosus.
Radiology 1998; 209 (1): 79-84.
38. Lim MK, Suh CH, Kim HJ, et al. Systemic lupus erythematosus: brain MR imaging
and single-voxel hydrogen 1 MR spectroscopy. Radiology 2000; 217 (1): 43-9.
39. Vermathen P, Ende G, Laxer KD, et al. Temporal lobectomy for epilepsy:
recovery of the contralateral hippocampus measured by (1)H MRS. Neurology
2002; 59 (4): 633-6.
40. Brooks WM, Sabet A, Sibbitt WL Jr, et al. Neurochemistry of brain lesions deter-
mined by spectroscopic imaging in systemic lupus erythematosus. J Rheumatol
1997; 24 (12): 2323-9.
Genome-wide association studies (GWAS) have identified
common variants of modest-effect size at hundreds of loci
for common autoimmune diseases; however, a substantial
fraction of heritability remains unexplained, to which rare
variants may contribute. To discover rare variants and test
them for association with a phenotype, most studies re-
sequence a small initial sample size and then genotype the
discovered variants in a larger sample set. This approach
fails to analyze a large fraction of the rare variants present
in the entire sample set. Hunt et al. performed simultaneous
amplicon-sequencing-based variant discovery and
genotyping for coding exons of 25 GWAS risk genes in 41,911
UK residents of white European origin, comprising 24,892
subjects with six autoimmune disease phenotypes and
17,019 controls. They showed that rare coding-region variants
at known loci have a negligible role in common autoimmune
disease susceptibility. These results do not support the rare-
variant synthetic genome-wide association hypothesis (in
which unobserved rare causal variants lead to association
detected at common tag variants). Many known autoimmune
disease risk loci contain multiple, independently associated,
common and low-frequency variants, and so genes at these
loci are a priori stronger candidates for harboring rare coding-
region variants than other genes. These data indicate that the
missing heritability for common autoimmune diseases may
not be attributable to the rare coding-region variant portion of
the allelic spectrum, but perhaps, as others have proposed,
may be a result of many common-variant loci of weak effect.
Nature 2013; 498: 232
Eitan Israeli
Capsule
Negligible impact of rare autoimmune-locus coding-region variants on missing heritability
“We should take care not to make the intellect our god; it has, of course, powerful
muscles, but no personality”
Albert Einstein (1879–1955), German-born theoretical physicist who developed the general theory of
relativity, one of the two pillars of modern physics alongside quantum mechanics