This document summarizes recent investigations in epilepsy, including various imaging and functional techniques. Neuroimaging techniques like fMRI, DTI, and PET can help localize epileptogenic foci and assess language dominance, memory function, and metabolic changes. SPECT and ictal-interictal subtraction can identify regions of hyperperfusion during seizures. MEG can localize irritative zones from magnetic fields generated by epileptic activity. Combined with MRI, these functional techniques provide valuable information to plan management of epilepsy.
This document discusses epilepsy surgery evaluation and outcomes. It notes that about one-third of epilepsy patients have seizures that cannot be controlled with medication. For these patients, surgical therapy can be an important treatment option. The goals of presurgical evaluation are to localize the epileptogenic zone and assess risk to brain functions from surgery. Evaluations may include brain imaging, video-EEG monitoring, neuropsychological testing, and in some cases invasive monitoring. Common indications for surgery include mesial temporal lobe epilepsy and lesions. Seizure freedom rates after surgery range from 50-90% depending on the specific diagnosis and evaluation findings. Outcome measures also consider cognitive and quality of life impacts.
Presentation1, radiological imaging of leigh disease.Abdellah Nazeer
Radiological imaging plays an important role in diagnosing and monitoring Leigh disease.
Leigh disease is a rare, progressive neurodegenerative disorder that typically presents in infants and leads to death in childhood. MRI is commonly used and shows characteristic symmetrical lesions in areas like the brainstem, basal ganglia, and thalamus. Over time, the lesions enlarge and involve more areas of the brain. Spectroscopy may reveal elevated lactate levels. The patterns of involvement on imaging can help confirm a diagnosis of Leigh disease.
This document discusses several types of complicated migraine syndromes including hemiplegic migraine, alternating hemiplegia of childhood, migraine with brainstem aura, retinal migraine, ophthalmoplegic migraine, and Alice in Wonderland syndrome. It provides details on symptoms, diagnostic criteria, potential causes or genetic factors, differential diagnoses, and treatment approaches for each type.
This document provides an overview of white matter diseases. It discusses:
1. Primary demyelinating diseases like multiple sclerosis and neuromyelitis optica which are characterized by loss of myelin.
2. Secondary demyelination caused by known etiologies like infections, metabolic disorders, or vascular issues which result in destruction of both axons and myelin.
3. Dysmyelinating/hypomyelinating leukodystrophies which involve defective or incomplete myelin formation, including some common causes like metachromatic leukodystrophy.
4. The clinical approach involves considering features like onset, progression, family history, involvement of other organs, and patterns
Dandy-Walker malformations involve a posterior fossa cyst, hydrocephalus, and hypoplasia of the cerebellar vermis. It can range from the classic triad to variants. Prenatal diagnosis is possible using ultrasound and amniocentesis. Treatment options include endoscopic third ventriculostomy as first line and shunt placement for younger patients, with the goal of managing increased intracranial pressure and hydrocephalus. Outcomes vary depending on associated anomalies, but mortality is around 10-20% and around half of patients experience subnormal intellectual or motor development.
Presentation1.pptx, radiological imaging of cerebral venous thrombosis.Abdellah Nazeer
This document provides an anatomical review of the cerebral venous system and discusses radiological imaging techniques for diagnosing cerebral venous thrombosis (CVT). It describes the normal anatomy of cerebral veins and venous sinuses that drain blood from the brain. Computed tomography and magnetic resonance imaging are effective noninvasive methods for identifying CVT. Direct signs on imaging include visualizing thrombus as hyperdense on CT or hyperintense on MRI. Indirect signs include edema, infarction, hemorrhage, and collateral vessel formation caused by venous outflow obstruction from thrombus.
The document summarizes MRI findings in Wilson disease. There are 5 main patterns seen: 1) T2 hyperintense lesions that are T1 hypointense, 2) lesions hypointense in the center and hyperintense peripherally on T2, 3) T1 hyperintense and T2 iso/hypointense lesions, 4) generalized brain atrophy, and 5) specific signs like the "face of giant panda" seen in the midbrain. Lesions are typically bilateral and symmetric. Later in the disease, iron deposition can cause hypointensity. Diffusion MRI may show early restricted diffusion. Characteristic signs have high specificity for Wilson disease.
1) The document discusses various causes of compressive myelopathy including spondylosis, herniated discs, spinal stenosis, and tuberculosis. It describes the clinical features and treatments for different levels of involvement in the cervical and lumbar spine.
2) Imaging techniques like MRI, CT myelogram, and X-rays are used to identify compression of the spinal cord or nerve roots from conditions like herniations, osteophytes, and tuberculosis lesions.
3) Surgical intervention may be indicated for moderate to severe myelopathy, progressive neurological deficits, or failure of conservative treatment. The goal is to decompress the spinal cord and relieve compression.
This document discusses epilepsy surgery evaluation and outcomes. It notes that about one-third of epilepsy patients have seizures that cannot be controlled with medication. For these patients, surgical therapy can be an important treatment option. The goals of presurgical evaluation are to localize the epileptogenic zone and assess risk to brain functions from surgery. Evaluations may include brain imaging, video-EEG monitoring, neuropsychological testing, and in some cases invasive monitoring. Common indications for surgery include mesial temporal lobe epilepsy and lesions. Seizure freedom rates after surgery range from 50-90% depending on the specific diagnosis and evaluation findings. Outcome measures also consider cognitive and quality of life impacts.
Presentation1, radiological imaging of leigh disease.Abdellah Nazeer
Radiological imaging plays an important role in diagnosing and monitoring Leigh disease.
Leigh disease is a rare, progressive neurodegenerative disorder that typically presents in infants and leads to death in childhood. MRI is commonly used and shows characteristic symmetrical lesions in areas like the brainstem, basal ganglia, and thalamus. Over time, the lesions enlarge and involve more areas of the brain. Spectroscopy may reveal elevated lactate levels. The patterns of involvement on imaging can help confirm a diagnosis of Leigh disease.
This document discusses several types of complicated migraine syndromes including hemiplegic migraine, alternating hemiplegia of childhood, migraine with brainstem aura, retinal migraine, ophthalmoplegic migraine, and Alice in Wonderland syndrome. It provides details on symptoms, diagnostic criteria, potential causes or genetic factors, differential diagnoses, and treatment approaches for each type.
This document provides an overview of white matter diseases. It discusses:
1. Primary demyelinating diseases like multiple sclerosis and neuromyelitis optica which are characterized by loss of myelin.
2. Secondary demyelination caused by known etiologies like infections, metabolic disorders, or vascular issues which result in destruction of both axons and myelin.
3. Dysmyelinating/hypomyelinating leukodystrophies which involve defective or incomplete myelin formation, including some common causes like metachromatic leukodystrophy.
4. The clinical approach involves considering features like onset, progression, family history, involvement of other organs, and patterns
Dandy-Walker malformations involve a posterior fossa cyst, hydrocephalus, and hypoplasia of the cerebellar vermis. It can range from the classic triad to variants. Prenatal diagnosis is possible using ultrasound and amniocentesis. Treatment options include endoscopic third ventriculostomy as first line and shunt placement for younger patients, with the goal of managing increased intracranial pressure and hydrocephalus. Outcomes vary depending on associated anomalies, but mortality is around 10-20% and around half of patients experience subnormal intellectual or motor development.
Presentation1.pptx, radiological imaging of cerebral venous thrombosis.Abdellah Nazeer
This document provides an anatomical review of the cerebral venous system and discusses radiological imaging techniques for diagnosing cerebral venous thrombosis (CVT). It describes the normal anatomy of cerebral veins and venous sinuses that drain blood from the brain. Computed tomography and magnetic resonance imaging are effective noninvasive methods for identifying CVT. Direct signs on imaging include visualizing thrombus as hyperdense on CT or hyperintense on MRI. Indirect signs include edema, infarction, hemorrhage, and collateral vessel formation caused by venous outflow obstruction from thrombus.
The document summarizes MRI findings in Wilson disease. There are 5 main patterns seen: 1) T2 hyperintense lesions that are T1 hypointense, 2) lesions hypointense in the center and hyperintense peripherally on T2, 3) T1 hyperintense and T2 iso/hypointense lesions, 4) generalized brain atrophy, and 5) specific signs like the "face of giant panda" seen in the midbrain. Lesions are typically bilateral and symmetric. Later in the disease, iron deposition can cause hypointensity. Diffusion MRI may show early restricted diffusion. Characteristic signs have high specificity for Wilson disease.
1) The document discusses various causes of compressive myelopathy including spondylosis, herniated discs, spinal stenosis, and tuberculosis. It describes the clinical features and treatments for different levels of involvement in the cervical and lumbar spine.
2) Imaging techniques like MRI, CT myelogram, and X-rays are used to identify compression of the spinal cord or nerve roots from conditions like herniations, osteophytes, and tuberculosis lesions.
3) Surgical intervention may be indicated for moderate to severe myelopathy, progressive neurological deficits, or failure of conservative treatment. The goal is to decompress the spinal cord and relieve compression.
The document discusses ring enhancing lesions seen on neuroimaging. These lesions appear as hypodense masses that enhance with contrast. Common causes include metastatic lesions, primary brain tumors, pyogenic brain abscesses, tuberculomas, cysticercus granuloma, demyelinating disorders, and opportunistic infections in HIV patients such as toxoplasmosis and primary CNS lymphoma. Differential diagnosis depends on location, size, enhancement pattern and associated findings on imaging and other tests.
Cerebral herniation occurs when brain tissue shifts from its normal position inside the skull due to swelling. This is usually caused by head injury, stroke, bleeding or tumors. There are several types of herniation including subfalcine, transtentorial, uncal, and cerebellar tonsillar herniation. Management involves reducing intracranial pressure through surgical removal of mass lesions, ventricular drainage, medical therapies like hyperventilation, hyperosmotic agents, induced hypertension, barbiturate coma or hypothermia, and in severe cases decompressive craniectomy. The condition progresses through stages as herniation worsens and involves specific neurological exam findings at each stage.
Imaging in neurology - normal MR Angio and VenographyNeurologyKota
There are two main types of MR angiography (MRA): contrast-enhanced (CE) MRA and non-contrast enhanced MRA, which includes time-of-flight (TOF) MRA and phase contrast (PC) MRA. CE MRA uses an injected gadolinium contrast agent and is faster than non-contrast MRA. TOF MRA detects blood flow without contrast but is susceptible to artifacts. PC MRA measures blood velocity and flow direction and can quantify blood flow. MR venography (MRV) uses similar techniques as MRA to image veins and is useful for detecting cerebral venous thrombosis. Common applications of MRA and MRV include evaluation of aneurysms, neck vessels, and cerebral
Damage to spinal cord structures can cause various impairments depending on the location and extent of the lesion. A complete transection of the spinal cord at L1 would cause ipsilateral loss of light touch and proprioception below the lesion, upper motor neuron signs ipsilaterally below, and contralateral loss of pain and temperature sensation. Epiconus syndrome from a lesion at L4-S2 is associated with weakness of hip and knee flexion and ankle movement with sensory loss from L4-S5 and loss of bladder and bowel control. Cutaneous reflexes and other reflexes have localizing value in myelopathy patients.
Human: Thank you for the summary. Can you provide a 3 sentence summary that focuses
This document provides guidance on evaluating patients presenting with paraplegia. It outlines the key components of the clinical history and neurological examination needed to determine the cause and level of spinal cord injury. The history should ascertain details of onset and any associated symptoms. The exam focuses on assessing sensory and motor function at different dermatomal and myotomal levels to localize the lesion. Together this information can indicate if the injury is acute, subacute, or chronic, and identify potential etiologies like trauma, infection, inflammation, compression, or vascular causes. The goal is to arrive at a diagnosis and localization of injury within the spinal cord or vertebrae.
CADASIL is caused by mutations in the NOTCH3 gene and is the most common monogenic form of cerebral small vessel disease. It is characterized clinically by recurrent strokes, cognitive decline, and mood disorders. Diagnosis involves identifying white matter changes, cerebral microbleeds, and NOTCH3 gene mutations on imaging and genetic testing. While there are currently no disease-modifying treatments, understanding the pathogenic mechanisms of CADASIL may help develop new therapeutic strategies.
This document provides information about glioblastoma multiforme (GBM), the most common and aggressive type of primary brain tumor. It discusses the causes, pathophysiology, clinical features, diagnosis, treatment, and prognosis of GBM. Key points include that the exact cause is unknown but genetic factors are involved; common symptoms depend on the tumor location in the brain; diagnosis involves biopsy and imaging; treatment involves surgery, radiation, chemotherapy and newer approaches; and prognosis is generally poor with median survival of 14 months despite treatment.
This document is a presentation on CT halo sign by Dr. Mazen Qusaibaty. It discusses what the CT halo sign refers to and provides examples of diseases that can present with the halo sign, including aspergillosis, eosinophilic pneumonia, bronchiolitis obliterans with organizing pneumonia, and others. Specific case examples are presented to illustrate the halo sign in diseases such as invasive pulmonary aspergillosis, Kaposi sarcoma, and eosinophilic pneumonia. The histological features underlying the halo sign are also described for different conditions.
1) The document discusses imaging in stroke, focusing on various modalities including CT, CT angiography, CT perfusion, MRI, diffusion weighted imaging, and perfusion weighted imaging.
2) These modalities are used to assess the brain parenchyma, vasculature, perfusion, and penumbra (area of reversible ischemia surrounding the irreversibly damaged core).
3) Identification of the penumbra is especially important as this region may be salvageable with early reperfusion and helps guide treatment decisions.
This document provides an approach to evaluating a case of quadriparesis (weakness of all four limbs). It discusses obtaining a detailed history regarding onset and progression of weakness, risk factors, and family history. A neurological examination including assessment of upper and lower motor neuron signs is recommended. Various etiologies are considered depending on examination findings such as compressive vs. non-compressive myelopathy, motor neuron disease, subacute combined degeneration, anterior spinal artery syndrome, and myasthenia gravis. Differential diagnoses are formulated based on characteristics such as sensory involvement, reflex changes, symmetry of weakness, and associated symptoms.
Intramedullary spinal cord lesions occur within the spinal cord itself while extramedullary lesions occur outside the spinal cord. Intramedullary lesions typically cause symmetrical symptoms that affect motor and sensory functions diffusely down the spinal cord, often with early sphincter involvement. In contrast, extramedullary lesions usually cause asymmetrical symptoms, with local or radicular pain and early upper motor neuron signs but later lower motor neuron signs and sensory involvement in the affected segment.
This document provides an overview of the approach to evaluating and diagnosing myopathies. It discusses the types of muscle fibers and symptoms that may be present in patients with myopathies. The evaluation involves assessing temporal evolution, distribution of weakness, family history, and laboratory/diagnostic testing including CK levels, EMG, and muscle biopsy. Causes of myopathies include genetic, acquired, inflammatory/immune, and those associated with other systemic illnesses. Specific myopathies discussed include central core disease, nemaline myopathy, and centronuclear myopathy.
Imaging evaluation of spectrum of infective pathologies of CNS including encephalitis,meningitis,abscesses,congenital pathologies and hiv associated conditions etc.
This document discusses various syndromes that can result from strokes in different areas of the brainstem. It begins with an overview of brainstem anatomy and blood supply. It then describes in detail the clinical presentations of medial and lateral midbrain syndromes, various pontine syndromes including medial and lateral inferior pontine syndromes, and medial and lateral medullary syndromes. Case examples are provided to illustrate the different neurological deficits that can occur based on the location of the brainstem stroke.
1) Neurological signs that indicate dysfunction in a different area of the brain than would be expected given the location of pathology are known as false localizing signs.
2) False localizing signs can occur due to compression of brain structures distant from the site of a lesion, such as cranial nerve palsies resulting from compression against the skull base.
3) Dysfunction of motor or sensory pathways can also produce false localizing signs, like contralateral hemiparesis from transtentorial herniation compressing the cerebral peduncle.
This document discusses stroke, including its types, causes, pathophysiology, imaging findings, and clinical features. It provides the following key points:
1. Stroke is caused by ischemia or hemorrhage in the brain. The main types are cerebral infarction (80%), intracerebral hemorrhage (15%), and subarachnoid hemorrhage (5%).
2. Imaging plays an important role in assessing the parenchyma, vessels, perfusion, and penumbra to guide therapy and predict outcomes. Techniques include CT, MRI, CT/MR perfusion, and angiography.
3. CT findings evolve over time from hyperacute to chronic stages. Early signs include
Progressive myoclonus epilepsies are characterized by myoclonic seizures, tonic-clonic seizures, and progressive neurological dysfunction including ataxia and dementia. The document discusses several specific causes of progressive myoclonus epilepsy including Unverricht-Lundborg disease, Lafora's disease, myoclonus epilepsy with ragged-red fibers, sialidoses, neuronal ceroid lipofuscinoses, and others. It provides details on clinical features, pathogenesis, diagnosis, and genetic basis for several of these conditions.
Pseudohypoparathyroidism is characterized by peripheral resistance to parathyroid hormone rather than a deficiency, causing hypocalcemia and hyperphosphataemia. There are three main types - 1a, 1b, and 2 - which are all heterozygous genetic conditions involving haploinsufficiency of the GNAS1 gene. Type 1a is associated with short stature, round face, soft tissue calcification, and developmental delays. The molecular defect is in the GNAS1 gene which encodes the Gsa protein involved in several hormone signaling pathways. Types 1b and 2 also involve GNAS1 defects but have different clinical presentations and endocrinological effects.
This document discusses temporal lobe epilepsy and the MRI protocol for evaluating epilepsy. It notes that temporal lobe epilepsy is the most common form of epilepsy in adults and involves structures of the mesial temporal lobe like the hippocampus. The key MRI findings of hippocampal sclerosis include hippocampal atrophy on T1-weighted images, increased signal on T2-weighted and FLAIR images due to increased water content, and secondary findings like enlargement of the temporal horn and thinning of the fornix. The described MRI protocol for epilepsy includes T1-weighted, coronal FLAIR, and T2-weighted axial and coronal sequences.
Bronchitis is inflammation of the bronchial tubes caused by viruses, bacteria, or other irritants. It can be acute, lasting a few weeks, or chronic, characterized by a long-term productive cough. Symptoms include cough, mucus production, shortness of breath, wheezing, and chest discomfort. Treatment depends on the cause but may include antibiotics, cough medicine, bronchodilators, mucolytics, or steroids. Lifestyle changes like quitting smoking and avoiding irritants can help prevention.
The document discusses ring enhancing lesions seen on neuroimaging. These lesions appear as hypodense masses that enhance with contrast. Common causes include metastatic lesions, primary brain tumors, pyogenic brain abscesses, tuberculomas, cysticercus granuloma, demyelinating disorders, and opportunistic infections in HIV patients such as toxoplasmosis and primary CNS lymphoma. Differential diagnosis depends on location, size, enhancement pattern and associated findings on imaging and other tests.
Cerebral herniation occurs when brain tissue shifts from its normal position inside the skull due to swelling. This is usually caused by head injury, stroke, bleeding or tumors. There are several types of herniation including subfalcine, transtentorial, uncal, and cerebellar tonsillar herniation. Management involves reducing intracranial pressure through surgical removal of mass lesions, ventricular drainage, medical therapies like hyperventilation, hyperosmotic agents, induced hypertension, barbiturate coma or hypothermia, and in severe cases decompressive craniectomy. The condition progresses through stages as herniation worsens and involves specific neurological exam findings at each stage.
Imaging in neurology - normal MR Angio and VenographyNeurologyKota
There are two main types of MR angiography (MRA): contrast-enhanced (CE) MRA and non-contrast enhanced MRA, which includes time-of-flight (TOF) MRA and phase contrast (PC) MRA. CE MRA uses an injected gadolinium contrast agent and is faster than non-contrast MRA. TOF MRA detects blood flow without contrast but is susceptible to artifacts. PC MRA measures blood velocity and flow direction and can quantify blood flow. MR venography (MRV) uses similar techniques as MRA to image veins and is useful for detecting cerebral venous thrombosis. Common applications of MRA and MRV include evaluation of aneurysms, neck vessels, and cerebral
Damage to spinal cord structures can cause various impairments depending on the location and extent of the lesion. A complete transection of the spinal cord at L1 would cause ipsilateral loss of light touch and proprioception below the lesion, upper motor neuron signs ipsilaterally below, and contralateral loss of pain and temperature sensation. Epiconus syndrome from a lesion at L4-S2 is associated with weakness of hip and knee flexion and ankle movement with sensory loss from L4-S5 and loss of bladder and bowel control. Cutaneous reflexes and other reflexes have localizing value in myelopathy patients.
Human: Thank you for the summary. Can you provide a 3 sentence summary that focuses
This document provides guidance on evaluating patients presenting with paraplegia. It outlines the key components of the clinical history and neurological examination needed to determine the cause and level of spinal cord injury. The history should ascertain details of onset and any associated symptoms. The exam focuses on assessing sensory and motor function at different dermatomal and myotomal levels to localize the lesion. Together this information can indicate if the injury is acute, subacute, or chronic, and identify potential etiologies like trauma, infection, inflammation, compression, or vascular causes. The goal is to arrive at a diagnosis and localization of injury within the spinal cord or vertebrae.
CADASIL is caused by mutations in the NOTCH3 gene and is the most common monogenic form of cerebral small vessel disease. It is characterized clinically by recurrent strokes, cognitive decline, and mood disorders. Diagnosis involves identifying white matter changes, cerebral microbleeds, and NOTCH3 gene mutations on imaging and genetic testing. While there are currently no disease-modifying treatments, understanding the pathogenic mechanisms of CADASIL may help develop new therapeutic strategies.
This document provides information about glioblastoma multiforme (GBM), the most common and aggressive type of primary brain tumor. It discusses the causes, pathophysiology, clinical features, diagnosis, treatment, and prognosis of GBM. Key points include that the exact cause is unknown but genetic factors are involved; common symptoms depend on the tumor location in the brain; diagnosis involves biopsy and imaging; treatment involves surgery, radiation, chemotherapy and newer approaches; and prognosis is generally poor with median survival of 14 months despite treatment.
This document is a presentation on CT halo sign by Dr. Mazen Qusaibaty. It discusses what the CT halo sign refers to and provides examples of diseases that can present with the halo sign, including aspergillosis, eosinophilic pneumonia, bronchiolitis obliterans with organizing pneumonia, and others. Specific case examples are presented to illustrate the halo sign in diseases such as invasive pulmonary aspergillosis, Kaposi sarcoma, and eosinophilic pneumonia. The histological features underlying the halo sign are also described for different conditions.
1) The document discusses imaging in stroke, focusing on various modalities including CT, CT angiography, CT perfusion, MRI, diffusion weighted imaging, and perfusion weighted imaging.
2) These modalities are used to assess the brain parenchyma, vasculature, perfusion, and penumbra (area of reversible ischemia surrounding the irreversibly damaged core).
3) Identification of the penumbra is especially important as this region may be salvageable with early reperfusion and helps guide treatment decisions.
This document provides an approach to evaluating a case of quadriparesis (weakness of all four limbs). It discusses obtaining a detailed history regarding onset and progression of weakness, risk factors, and family history. A neurological examination including assessment of upper and lower motor neuron signs is recommended. Various etiologies are considered depending on examination findings such as compressive vs. non-compressive myelopathy, motor neuron disease, subacute combined degeneration, anterior spinal artery syndrome, and myasthenia gravis. Differential diagnoses are formulated based on characteristics such as sensory involvement, reflex changes, symmetry of weakness, and associated symptoms.
Intramedullary spinal cord lesions occur within the spinal cord itself while extramedullary lesions occur outside the spinal cord. Intramedullary lesions typically cause symmetrical symptoms that affect motor and sensory functions diffusely down the spinal cord, often with early sphincter involvement. In contrast, extramedullary lesions usually cause asymmetrical symptoms, with local or radicular pain and early upper motor neuron signs but later lower motor neuron signs and sensory involvement in the affected segment.
This document provides an overview of the approach to evaluating and diagnosing myopathies. It discusses the types of muscle fibers and symptoms that may be present in patients with myopathies. The evaluation involves assessing temporal evolution, distribution of weakness, family history, and laboratory/diagnostic testing including CK levels, EMG, and muscle biopsy. Causes of myopathies include genetic, acquired, inflammatory/immune, and those associated with other systemic illnesses. Specific myopathies discussed include central core disease, nemaline myopathy, and centronuclear myopathy.
Imaging evaluation of spectrum of infective pathologies of CNS including encephalitis,meningitis,abscesses,congenital pathologies and hiv associated conditions etc.
This document discusses various syndromes that can result from strokes in different areas of the brainstem. It begins with an overview of brainstem anatomy and blood supply. It then describes in detail the clinical presentations of medial and lateral midbrain syndromes, various pontine syndromes including medial and lateral inferior pontine syndromes, and medial and lateral medullary syndromes. Case examples are provided to illustrate the different neurological deficits that can occur based on the location of the brainstem stroke.
1) Neurological signs that indicate dysfunction in a different area of the brain than would be expected given the location of pathology are known as false localizing signs.
2) False localizing signs can occur due to compression of brain structures distant from the site of a lesion, such as cranial nerve palsies resulting from compression against the skull base.
3) Dysfunction of motor or sensory pathways can also produce false localizing signs, like contralateral hemiparesis from transtentorial herniation compressing the cerebral peduncle.
This document discusses stroke, including its types, causes, pathophysiology, imaging findings, and clinical features. It provides the following key points:
1. Stroke is caused by ischemia or hemorrhage in the brain. The main types are cerebral infarction (80%), intracerebral hemorrhage (15%), and subarachnoid hemorrhage (5%).
2. Imaging plays an important role in assessing the parenchyma, vessels, perfusion, and penumbra to guide therapy and predict outcomes. Techniques include CT, MRI, CT/MR perfusion, and angiography.
3. CT findings evolve over time from hyperacute to chronic stages. Early signs include
Progressive myoclonus epilepsies are characterized by myoclonic seizures, tonic-clonic seizures, and progressive neurological dysfunction including ataxia and dementia. The document discusses several specific causes of progressive myoclonus epilepsy including Unverricht-Lundborg disease, Lafora's disease, myoclonus epilepsy with ragged-red fibers, sialidoses, neuronal ceroid lipofuscinoses, and others. It provides details on clinical features, pathogenesis, diagnosis, and genetic basis for several of these conditions.
Pseudohypoparathyroidism is characterized by peripheral resistance to parathyroid hormone rather than a deficiency, causing hypocalcemia and hyperphosphataemia. There are three main types - 1a, 1b, and 2 - which are all heterozygous genetic conditions involving haploinsufficiency of the GNAS1 gene. Type 1a is associated with short stature, round face, soft tissue calcification, and developmental delays. The molecular defect is in the GNAS1 gene which encodes the Gsa protein involved in several hormone signaling pathways. Types 1b and 2 also involve GNAS1 defects but have different clinical presentations and endocrinological effects.
This document discusses temporal lobe epilepsy and the MRI protocol for evaluating epilepsy. It notes that temporal lobe epilepsy is the most common form of epilepsy in adults and involves structures of the mesial temporal lobe like the hippocampus. The key MRI findings of hippocampal sclerosis include hippocampal atrophy on T1-weighted images, increased signal on T2-weighted and FLAIR images due to increased water content, and secondary findings like enlargement of the temporal horn and thinning of the fornix. The described MRI protocol for epilepsy includes T1-weighted, coronal FLAIR, and T2-weighted axial and coronal sequences.
Bronchitis is inflammation of the bronchial tubes caused by viruses, bacteria, or other irritants. It can be acute, lasting a few weeks, or chronic, characterized by a long-term productive cough. Symptoms include cough, mucus production, shortness of breath, wheezing, and chest discomfort. Treatment depends on the cause but may include antibiotics, cough medicine, bronchodilators, mucolytics, or steroids. Lifestyle changes like quitting smoking and avoiding irritants can help prevention.
Approach to temporal lobe anatomy,function,epilepsy MRI findingDr Surendra Khosya
A 40-year-old lawyer experienced seizures and was found to have a left temporal lobe tumor. After the tumor was removed, he had word-finding difficulties but was able to return to work. The temporal lobe is located at the side of the head and is involved in functions like auditory and visual processing, memory, emotion, and language. It contains areas important for these functions and connects to other brain regions. Disorders of the temporal lobe can cause issues with perception, attention, memory, personality, and behavior.
This document provides definitions and classifications of seizures and epilepsy. It discusses who needs neuroimaging for epilepsy and recommends MRI as the best imaging modality. It reviews common MRI protocols and discusses key imaging findings and features of various epilepsy etiologies. Recent advances in neuroimaging for epilepsy are also summarized, including quantitative MRI techniques like volumetry, voxel-based morphometry, and texture analysis as well as advanced techniques like diffusion tensor imaging, tractography, magnetic resonance spectroscopy, and functional MRI.
This chapter defines an epileptic seizure as transient abnormal neuronal activity in the brain. Around 5% of people experience seizures in their lifetime, with incidence highest in infants and elderly adults. Epilepsy is defined as recurrent seizures and the consequences of this condition. A diagnosis of epilepsy can be made after one seizure if EEG or MRI findings indicate increased epileptogenicity. Drug-resistant epilepsy persists despite adequate treatment with two tolerated anti-seizure medications. Seizure freedom requires being seizure-free for at least one year while on medication.
Presentation1.pptx. radiological imaging of epilepsy.Abdellah Nazeer
1) Hippocampal sclerosis, characterized by hippocampal atrophy and increased signal intensity on MRI, is the most common epileptogenic abnormality found after epilepsy surgery.
2) Malformations of cortical development, including focal cortical dysplasias and heterotopias, are also common epileptogenic lesions found in surgical series, especially in patients with childhood-onset seizures.
3) In addition to structural abnormalities, low-grade gliomas and hamartomas located near the cerebral cortex are also important causes of drug-resistant epilepsy that may require surgery.
The temporal lobes are located inside the temples on both sides of the brain. They are divided into superior, middle, and inferior temporal lobes. The temporal lobes are involved in auditory processing, language comprehension, visual recognition, memory formation, and emotional processing. Disorders of the temporal lobes can cause issues with auditory and visual perception, attention, memory, language, personality, and behavior. The amygdala and hippocampus, located within the medial temporal lobes, are important for processing emotions and forming memories.
This document provides an overview of CT and MRI interpretation for various neurological conditions. It begins with examples of MRI sequences showing normal brain anatomy and proceeds to discuss key pathologies including infarction, hemorrhage, infection, tumors, trauma, dementia, multiple sclerosis, epilepsy, and cranial neuropathies. For each condition, representative imaging findings are presented and briefly described to aid in diagnosis and clinical management. The document serves as an educational guide for interpreting neuroimaging studies.
This document discusses imaging in medial temporal lobe epilepsy. It begins by explaining why MRI is important for detecting epileptogenic lesions in refractory cases. It then describes the anatomy of medial temporal lobe structures like the hippocampus and amygdala. The document discusses how hippocampal sclerosis appears on MRI, including features like gliosis, neuronal loss, and atrophy. It also covers other imaging modalities that can help lateralize the seizure focus, such as hippocampal volumetry, relaxometry, MRS, PET, and SPECT. In conclusion, MRI is the best way to diagnose mesial temporal sclerosis by identifying hippocampal hyperintensity and atrophy.
The temporal lobe plays important roles in processing sensory input such as auditory and visual information. It is involved in functions such as memory formation, emotion processing, and language comprehension. Damage to temporal lobe structures can cause symptoms like auditory or visual processing issues, memory impairments, and changes in emotional behavior or personality. The superior, middle, and inferior temporal gyri and medial temporal structures each contribute to these various temporal lobe functions.
Epilepsy is a disorder caused by abnormal electrical activity in the brain that causes seizures. Seizures occur when groups of nerve cells, or neurons, in the brain send out abnormal burst of electrical activity. The main types of seizures are generalized seizures, which involve the whole brain, and partial seizures, which originate in one area of the brain. Epilepsy has many potential causes including genetic factors, brain injury, infections, tumors, and metabolic imbalances. Treatment involves medications to control seizures and lifestyle modifications to prevent injury during seizures.
Emerging MRI and metabolic neuroimaging techniques in mild traumatic brain in...IntesarAldweri
Traumatic brain injury (TBI) is one of the leading causes of death worldwide, and mild traumatic brain injury (mTBI) is the most common traumatic injury.
Tractography uses diffusion MRI to visually represent nerve tracts in the brain through 3D modeling. It can reveal both long tracts connecting different brain regions and more complex short circuits within the brain. However, nerve tracts are not directly visible through standard imaging techniques. Diffusion MRI measures the directionality of water diffusion within tissues to infer the orientation of fiber tracts. Software then maps the diffusion data to generate color-coded 3D representations of tracts called tractograms. Tractography provides insights into the structure and integrity of white matter pathways in the living brain.
Preoperative assessment of epilepsy clinical & radiological, eeg, megDr Fakir Mohan Sahu
Preoperative Assessment of Epilepsy and their localization, clinical semiology and Radiological evaluation MRI imaging, Video EEG MEG SPECT PET and patient management conference explained in simplified way
This document summarizes the use of diffusion tensor imaging (DTI) and fiber tractography (FT) to visualize white matter fibers and fiber pathways in the brain. It discusses how DTI-FT can be used to evaluate various white matter abnormalities, developmental disorders, and cortical malformations. Specifically, it provides examples of how DTI-FT can demonstrate abnormalities of fiber integrity and orientation in conditions such as agenesis of the corpus callosum, heterotopic gray matter, focal cortical dysplasia, periventricular nodular heterotopia, and polymicrogyria. The document also outlines the development of major white matter tracts and fiber pathways that can be visualized with DTI-FT.
Recent Modalities of Neuro-imaging discusses various imaging techniques used to image the brain and spinal cord, including:
- Computed tomography perfusion which uses contrast to generate maps of cerebral blood flow, volume, and transit time to identify ischemic tissue.
- Myelography which uses intrathecal contrast for spinal imaging.
- Magnetic resonance techniques like quantitative MRI, diffusion tensor imaging, and MR spectroscopy which provide microstructural data on tissues.
- Perfusion imaging uses ultrasound contrast to assess cerebral blood flow.
Imaging findings are discussed for conditions like multiple sclerosis, epilepsy, and stroke.
The study recorded EEG signals simultaneously from the scalp and thalamus of 7 patients undergoing deep brain stimulation for essential tremor. The patients performed a go/no-go task where they had to either execute or withhold a cued finger movement based on subsequent go or no-go cues. Event-related potentials differentiated between go and no-go conditions earlier at thalamic recording sites compared to scalp sites, suggesting the thalamus is involved in early classification of go and no-go instructions. Correlations between thalamic and frontal scalp responses were stronger for no-go activities, indicating the thalamus provides information to frontal areas involved in inhibiting prepared actions. The findings support a role for the thalamus
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PET and SPECT are functional brain imaging techniques. PET has higher resolution but is more expensive, while SPECT has lower resolution but is less expensive. Both techniques involve injecting radioactive tracers and detecting their location in the brain to map blood flow and metabolic activity. fMRI is another functional imaging technique that detects changes in blood oxygenation to map brain activity.
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This document analyzes regional differences in neonatal sleep EEG recordings through quantitative analysis. 21 healthy full-term newborns underwent polygraphic recordings including 8-channel EEG during sleep. EEG signals from different brain regions were automatically analyzed and described using 13 variables. Statistical analysis found significant differences between brain regions, with posterior-medial regions exhibiting higher spectral feature values and variability. Differences were also seen between left and right anterior regions. The automatic analysis method was able to detect physiological regional differences in neonatal EEG.
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1) Proton MR spectroscopy provides greater tissue characterization than MR imaging alone by detecting metabolic abnormalities. It can be performed on most clinical 1.5T MR units in 10-15 minutes without significant additional scan time.
2) The technique detects metabolite concentrations based on peak intensities and locations on generated spectra graphs. The most commonly detected brain metabolites are NAA, creatine, choline, and lactate. Abnormal concentrations of these metabolites can indicate various neurological conditions.
3) Proton MR spectroscopy is useful for evaluating tumors, infections, demyelinating diseases, and other neurological disorders by detecting deviations from normal metabolite levels and ratios that provide physiological information about tissue status.
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PET scans use radioactive tracers and detectors to generate 3D images of metabolic processes in the body. They have various applications in neurology for diagnosing and monitoring conditions like dementia, epilepsy, movement disorders, and brain tumors. For example, PET can help differentiate Alzheimer's from other dementias based on patterns of hypometabolism in temporal and parietal lobes. It is also useful for localizing epileptic foci before epilepsy surgery. The document discusses the history, mechanisms, common tracers, and limitations of PET scanning as well as its role in evaluating specific neurological conditions and potential future applications.
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Magnetic resonance spectroscopy (MRS) is a noninvasive imaging technique that measures metabolite levels in tissues. It works by detecting signals from atomic nuclei such as hydrogen placed in a strong magnetic field. MRS is useful for evaluating brain tumors, infections, demyelinating diseases, and neurodegenerative conditions. It provides diagnostic information by analyzing peak levels of metabolites including NAA, creatine, choline, and lactate. MRS can help distinguish tumors from other lesions, detect radiation necrosis, and monitor treatment response. It is also used to diagnose inborn errors of metabolism and mitochondrial disorders.
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Tognoli & Kelso, Society for Neuroscience 2009, diversity of 10Hz rhythms in ...EmmanuelleTognoli
This document discusses the heterogeneity of 10Hz rhythms seen in EEG data and proposes guidelines for their proper measurement and analysis. It presents a tentative dictionary of various 10Hz rhythms distinguished by their spatial distribution, frequency localization, and functional significance. It also puts forth a theory relating EEG spectral peaks to instantaneous brain oscillation patterns, and how the time scale of analysis impacts which patterns appear as peaks. Analyzing 10Hz rhythms at a fine spectral resolution and temporal scale can provide insights into distinct brain processes and functions.
This document summarizes a study that used functional magnetic resonance imaging (fMRI) and near-infrared spectroscopy (NIRS) to measure hemodynamic changes in the brain of zebra finches in response to hypercapnia. Hypercapnia induces vasodilation and is often used to model hemodynamic responses. Both fMRI, which detects blood oxygen level-dependent (BOLD) signals, and NIRS, which measures concentrations of oxyhemoglobin and deoxyhemoglobin, clearly showed increases in blood oxygen saturation in the brain during hypercapnia. The results provide the first correlation in songbirds between hemodynamic parameter variations measured by NIRS and local BOLD signal variations measured by fMRI.
MRI has become an integral imaging tool over the last 20 years. It uses magnetic fields and radio waves to create detailed images of organs and tissues without exposing patients to ionizing radiation. Different pulse sequences (T1, T2, proton density etc.) along with contrast agents allow MRI to characterize soft tissues and pathology. It is commonly used to image the brain, spine, joints, soft tissues, and for angiography. Recent advances include diffusion MRI, spectroscopy, and functional MRI. MRI has good soft tissue contrast but is more expensive than other modalities.
The document discusses electrophysiology techniques used to study the electrical activity of neurons and other excitable cells. It begins by explaining that electrophysiology allows measurement of ionic currents across cell membranes and helps understand how cells and tissues function. Different techniques are then described, including intracellular recordings, patch clamp recordings, and extracellular recordings. The document outlines the historical development of the field and covers topics like resting membrane potentials, action potentials, ion channels, and how neurons encode and transmit information.
The document discusses neuroimmunology and provides information on the immune system and its normal functions and disorders. It describes the innate and adaptive immune systems, including skin, phagocytes, natural killer cells, the complement system, antibodies, B cells, antigen presenting cells, major histocompatibility complex, toll-like receptors, T lymphocytes, cluster of differentiation markers, cytokines, chemokines, initiation and regulation of the immune response, termination of the immune response, self-tolerance, central tolerance, peripheral tolerance, anergy, regulatory T cells, immune privilege in the central nervous system, and several immune-mediated disorders of the nervous system including multiple sclerosis, myasthenia gravis, Guillain-Barré syndrome
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The document discusses the importance of carefully considering alternative diagnoses to multiple sclerosis (MS) when evaluating patients. Common causes of MS misdiagnosis include nonspecific white matter abnormalities on brain MRI and vague neurological symptoms. Other disorders like neuromyelitis optica spectrum disorders, acute disseminated encephalomyelitis, and inherited disorders can mimic MS clinically and radiologically. A thorough evaluation of demographic, clinical, laboratory, and imaging factors is necessary to avoid misdiagnosis, as an MS diagnosis has significant implications for treatment.
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- Alternative hypotheses for Alzheimer's causation include neuroinflammation, oxidative stress, metabolic dysfunction, and aging. Strategies targeting these pathways also have not resulted in effective treatments.
- The exact causes and mechanisms of Alzheimer's remain unclear as amyloid and tau are normal brain proteins and their roles are still being understood. Further research is still needed to determine the root causes and identify effective treatments for this devastating disease.
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- Major risk factors include hypertension, atrial fibrillation, diabetes, hyperlipidemia and previous stroke or TIA.
- Clinical syndromes depend on the location of brain infarction and can include motor/sensory deficits, aphasia and visual field cuts.
- Diagnosis involves neuroimaging such as CT, MRI and vascular imaging to identify the cause.
- Acute
Skeletal muscle disorders can be classified as either primary muscle diseases or secondary disorders caused by other conditions like inflammation, metabolic abnormalities, or drugs. Progressive muscle dystrophies are a primary cause and include Duchenne muscular dystrophy and Becker muscular dystrophy, which are caused by mutations in the dystrophin gene. Symptoms include weakness, wasting, and pseudohypertrophy. Management focuses on rehabilitation, steroids, respiratory support, and future gene therapies. Myasthenia gravis is an autoimmune disorder where antibodies target acetylcholine receptors, causing fluctuating weakness. Diagnosis involves the Tensilon test and repetitive nerve stimulation with treatment consisting of cholinesterase inhibitors, steroids, plasma exchange,
Approach to disturbance of consciousnessOsama Ragab
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Multiple sclerosis (MS) is a chronic inflammatory disease of the central nervous system characterized by breakdown of the myelin sheath covering nerve axons. It affects over 400,000 people in the US and more than 2.1 million worldwide. Genetic factors, autoimmunity, infection, vitamin D levels, and loss of protective childhood infections may play a role in MS etiology. Clinically, MS presents with a variety of neurological symptoms depending on the location of lesions in the brain and spinal cord, including visual, motor, sensory and cognitive impairments. Disease courses include relapsing-remitting MS, secondary progressive MS, primary progressive MS and progressive-relapsing MS.
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non motor manifestation of parkinson diseaseOsama Ragab
This document discusses non-motor symptoms of Parkinson's disease. It begins by providing background on the original description of Parkinson's disease in 1817 and defines it as primarily affecting motor functions. However, it notes that nearly 90% of Parkinson's patients experience non-motor manifestations as well, including neuropsychiatric symptoms, sleep disorders, autonomic dysfunction, sensory symptoms, and other issues. The document then examines the roles of different neurotransmitter systems including dopamine, serotonin, norepinephrine, glutamate, and GABA in both motor and non-motor features of the disease.
This document discusses the effects of epilepsy and anti-epileptic drug (AED) use on reproductive health and pregnancy outcomes. It notes that women with epilepsy have an increased risk of gestational hypertension, preterm delivery, fetal malformations, and low birthweight infants. During pregnancy, AED levels may decrease due to changes in metabolism and clearance, increasing seizure risk. Close monitoring of drug levels and seizures is recommended during pregnancy to adjust dosages as needed. Folic acid supplementation is also advised to reduce the risk of neural tube defects.
This document discusses higher cortical functions and the neuroanatomy that supports them. It describes how different areas of the cerebral cortex are involved in functions like memory, language, reasoning and more. It discusses the primary and association areas, and how they communicate to allow for complex functions. It also summarizes different types of agnosias that can occur from damage to various cortical areas, disrupting abilities like object recognition, face recognition, and spatial attention.
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
Rasamanikya is a excellent preparation in the field of Rasashastra, it is used in various Kushtha Roga, Shwasa, Vicharchika, Bhagandara, Vatarakta, and Phiranga Roga. In this article Preparation& Comparative analytical profile for both Formulationon i.e Rasamanikya prepared by Kushmanda swarasa & Churnodhaka Shodita Haratala. The study aims to provide insights into the comparative efficacy and analytical aspects of these formulations for enhanced therapeutic outcomes.
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
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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
Promoting Wellbeing - Applied Social Psychology - Psychology SuperNotesPsychoTech Services
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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.
2. introduction
Epilepsy is a common, chronic neurologic
disorder characterized by recurrent,
unprovoked seizures .
The aim of investigation
1- Diagnoses an exclude DD.
2- Help to plan way of management.
3- Research ( exploring pathology, novel
treatments)
5. Neuro-imaging
Neuroimaging techniques play a major role in
epileptogenic focus localization, and are
particularly effective in high definition structural
studies, which allow for the localization of
epileptogenic focus in almost 90% of patients
with temporal lobe epilepsy (TLE).
CT brain and MRI is out of scope in this talk.
7. Functional magnetic resonance imaging
The fMRI technique is BOLD, (blood oxygen level
dependent )which relies on the signal changes
that occur in the venous flow as a result of
excessive deoxyhaemoglobin following a rise in
perfusion during brain activation.
Signal changes occurring during brain activation
are very subtle, and thus it is advisable to use
high-field MRI systems.
In clinical practice, most fMRI studies can be
performed on a 1.5-T scanner, although 3-T
scanners are the best.
8. Functional magnetic resonance imaging
when a seizure is generated, giving rise to
excessive brain activity, there will be changes
in the BOLD signal of the areas involved.
It has been demonstrated that there is a
significant increase at ictal onset that co-
occurs with the electrical changes.
Increases in BOLD signal spread to other
brain areas, helping to identify the seizure
propagation pattern.
9. performance of ictal fMRI is complex.
The image artifacts produced by motion of
patients during seizure are a major drawback.
In fact, only patients with partial and non-
motor seizures are candidates for this
technique.
Furthermore, an electroencephalography
(EEG) recording is necessary during the fMRI
acquisition period to correlate functional data
with electrical brain activity.
Functional magnetic resonance imaging
10. Ictal SPECT and pre-ictal BOLD.
SPECT images on the left and fMRI
images on the right.
Top row Pre-ictal BOLD increases in
the left premotor/prefrontal area at
the grey–white junction (arrows)
correspond with ictal hyperperfusion
near these sites with SPECT
(arrowheads).
Bottom row Pre-ictal BOLD signal
increases (arrow) in the left caudate
nucleus, have a similar location to
ictal ECD SPECT hyperperfusion
(arrowhead)
Functional magnetic resonance imaging
11. BOLD signal changes in
response to ictus.
Activation in the thalamus
bilaterally, superior and
middle frontal gyrus
bilaterally, occipital cortex
bilaterally, and posterior
cingulate.
deactivation in the caudate
nucleus bilaterally ,uncus
bilaterally , middle frontal
gyrus and posterior cingulate
bilaterally, and brainste
Functional magnetic resonance imaging
12. fMRI studies have also been used for the
anatomical localization of language areas.
Exact localization of the regions that control
language functions varies significantly between
subjects, and should be determined prior to
surgery .
It should be noted that there is a high incidence
of atypical language lateralization in epilepsy
patients, and particularly, in child-onset epilepsy
patients.
Therefore, in epilepsy surgery language areas,
fMRI can help in the localization of these cortical
fMRI and determination of language hemispheric
dominance.
13. fMRI and determination of language hemispheric
dominance.
in pediatric patients with hemispheric lesions,
such as cerebral infarction and encephalitis, brain
functions may be reorganized or transferred to the
non-affected hemisphere. For this reason,
dominant hemisphere determination is critical for
functional hemispherectomy.
Some authors have reported interesting cases in
which Broca’s area of certain patients is located in
one hemisphere and Wernicke’s area is located in
the contralateral one,This condition, known as
‘‘interhemispheric dissociation of frontal and
temporal regions’’.
14. Language functional MRI with a
word-generation pradigm.
(A) Right-handed subject.
Activation is observed in the left
inferior frontal gyrus (Broca’s
area) (arrow) and in the left
posterior temporal gyrus
(Wernicke’s area) (filled arrow)
demonstrating left-hemispheric
language dominance.
(B) Lefthanded subject. Activation
is obtained in the right inferior
frontal gyrus and dorsolateral right
cortex, showing right-hemispheric
language dominance.
fMRI and determination of language hemispheric
dominance.
15. (A) Language functional MRI with
an auditory comprehension
paradigm. Structural axial images
fused with the activation maps in
the frontotemporal region in an
epilepsy patient with a history of
meningitis at the age of three.
Activation is obtained in the
posterior temporal region,
demonstrating right-hemispheric
language dominance.
(B) Structural axial T2-weighted
images show cortical atrophy of
left hemisphere and signal
changes of the left temporal lobe.
fMRI and determination of language hemispheric
dominance.
16. Language functional MRI
with a word-generation
paradigm in an epilepsy
patient with a partially
resected left astrocytoma in
the insular region of the
brain.
Structural axial images
fused with the activation
maps in the frontotemporal
region. Activation is
observed in the left inferior
frontal region adjacent to
the mass.
fMRI and determination of language hemispheric
dominance.
17. Functional magnetic resonance for memory evaluation
there is a large number of different fMRI
experiments for memory assessment using
different stimuli, including words, faces,
objects, scenes and routes, memory functions
(retrieval and encoding).
The majority of these studies have shown
activation of the prefrontal cortex and mesial
temporal structures.
The posterior body of the hippocampus, the
parahippocampal and fusiform gyri are the
mesial temporal regions that show higher
activation.
18. Memory functional MRI
with a retrieval paradigm.
Group study in patients
with right temporal epilepsy.
Structural coronal images
fused with the activation
map show unilateral
activation in left mesial
temporal structures (arrow)
and bilateral though right-
predominant activation of
the prefrontal cortex.
Functional magnetic resonance for memory evaluation
20. MRI morphometric analysis
MRI volumetry and morphometry are involved in
comparing the size and shape of brain structures.
In the case of voxel-based morphometry (VBM), this
is done by spatially normalizing all images,
segmenting gray matter from images, and then
performing voxelwise parametric statistical tests to
produce a parametric map of structural regions .
A voxel (volumetric pixel or Volumetric Picture
Element) is a volume element, representing a value
on a regular grid in three dimensional space. This is
analogous to a pixel, which represents 2D image
data.
21. MRI volumetry has revealed smaller
ipsilateral thalamic volumes in TLE
patients with febrile seizures than in those
without.
patients with TLE exhibit gray matter
volume reduction and other structural
abnormalities in the hippocampus and
thalamus. These abnormalities were more
severe in those who also had MTS .
MRI morphometric analysis
24. Proton magnetic resonance
spectroscopy
Proton magnetic resonance spectroscopy
(PMRS) and imaging (PMRSI) are noninvasive
techniques for exploring the metabolic status
of the brain in health and in disease .
The four major metabolites detected by PMRS
at long times are N-acetylaspartate (NAA),
creatine (Cr), choline-containing phospholipids
(Cho) and lactate (Lac).
25. Proton magnetic resonance
spectroscopy
NAA is a neuronal and axonal marker that
decreases with neuronal loss or dysfunction.
Cr, either alone or as phosphocreatine, is a
marker for intact brain energy metabolism.
Cho is a marker for membrane synthesis or
repair, inflammation, or demyelination.
Lac is a metabolite of anaerobic glycolysis .
26. Using PMRS to measure in vivo temporal lobe
metabolite concentrations in patients with TLE
there is a bilateral reduction of N-acetyl
aspartate (NAA) to creatine plus
phosphocreatine (Cr) ratio (NAA/Cr) in the
temporal lobe.
normalization of NAA/Cr in the contralateral
temporal lobe was seen following successful
temporal lobe resection .
Proton magnetic resonance
spectroscopy
28. Diffusion tensor imaging
Diffusion tensor imaging (DTI) measures
diffusion properties of water protons in tissue
and can detect subtle white matter changes in
the pathological state .
Apparent diffusion coefficient (ADC) is an
average measure of water diffusion .
fractional anisotropy (FA) measures the
degree of alignment of cellular structures
within a tissue (e.g., white matter fiber tracts),
with 0 being the least anisotropic and 1 being
highly anisotropic .
29. DTI tractography and electron
microscopy of the fimbria-fornix.
Histological fields of the fimbria-
fornix resected during surgery
from two patients with TLE are
shown with their corresponding
FA maps (A and D, with the left
fimbria-fornix marked as green)
and tractography of the fimbria-
fornix (B and E). The patient
withMTS shows lower diffusion
anisotropy of the fimbria-fornix
(B) than the patient without MTS
(E).
This corresponds to lower axonal
density for the patient with MTS
(C) than for the patient without
MTS (F).
Diffusion tensor imaging
32. SPECT
Brain perfusion SPECT imaging is a functional
brain examination technique that relies on
tracers that have the ability to cross the blood-
brain barrier and distribute inside brain cells in
proportion to cerebral blood flow.
These tracers are hexamethylpropyleneamine
oxime (HMPAO) and ethylcysteinate dimer
(ECD), both labeled with technetium-99m
(Tc99m).
33. SPECT in temporal epilepsy
Interictal SPECT involves injecting the tracer
with the patient in baseline condition, at rest,
and seizure-free for over a 24-h period.
Interictal SPECT shows the EZ as a
hypoactive focal area, which means a low-
perfusion region.
34. Ictal SPECT involves tracer injection during the
epilepsy seizure and the images can be acquired
up to 2 h later, once the seizure has been
controlled.
SPECT shows an increase in
radiopharmaceutical uptake in the EZ secondary
to an increase in the regional cerebral blood flow
during the seizure.
Comparison of brain perfusion between ictal and
interictal SPECTs performed on the same patient
in two different situations may assist in localizing
the EZ with a diagnostic sensitivity > 90%.
postictal SPECT usually shows the EZ as focal
tracer hyperperfusion and diffuse lateral
hypoperfusion.
SPECT in temporal epilepsy
35. (A) interictal SPECT of a patient
with complex partial seizures in the
right temporal lobe.
(B) SPECT image shows an
increase in perfusion in the right
temporal lobe, exactly where the
EZ is located.
(C) Images showing fusion of the
ictal-interictal SPECT subtraction
coregistered to the MRI of the
same patient. An increase in
perfusion in the anterior pole of the
right temporal lobe with mesial
region predominance is observed.
SPECT in temporal epilepsy
36. SISCOM
SISCOM (Subtraction Ictal Spect Co-registered to
Magnetic Resonance Imaging) has been recently
implemented to optimize surgical outcomes by
combining SPECT and MRI images.
A SISCOM image results from fusing the
difference image between ictal SPECT and
interictal SPECT with the MRI image of the same
patient.
SISCOM plays a crucial role in treating patients
with malformations of cortical development
(MCD), since it has been demostrated that the
dysplastic area is not entirely epileptogenic.
37. Positron emission tomography.
The basis of fluorine-18-labeled fluorodeoxyglucose
(18FFDG) PET is that intracranial glucose distribution
equals cerebral metabolism.
ictal studies are difficult to obtain due to slow brain
glucose uptake and the short decomposition time of
18F.
Interictal PET detects a focal decrease in glucose
uptake, which is described as hypometabolism
reflecting a focal functional brain deficit associated
with the EZ.
PET sensitivity in mesial temporal epilepsy ranges
from 80% to 90%, and can detect focal temporal
hypometabolism in patients free of MRI-positive
mesial sclerosis.
38. Nine-year-old boy with
frontal seizures secondary
to left frontal focal cortical
dysplasia with normal MRI
findings.
Fluorine-18-labeled
fluorodeoxyglucose PET
image and PET/MRI fusion
image show
hypometabolism in the
anterior frontal region
(arrow).
Positron emission tomography.
40. Imaging of Specific
Neurotransmitter Systems
Neurochemical characterization of the different
cortical zones in the epileptic brain with the use of
specific receptor ligands is also of high interest.
GABA acts on 2 types of receptors: GABAA and
GABAB. Imaging of the GABAA receptor can be
done using either 11Cor 18F-labeled flumazenil
(FMZ).
11C-labeled FMZ binding was found to be
abnormal in gray and white matter in the brain of
75% of patients with different types of refractory
neocortical focal epilepsy.
41. Evidence suggest that serotonin (5-HT) may also
have an anticonvulsant effect through activation of
the 5-HT1A receptor, because activation of
this receptor affects the release and activity of
other neurotransmitters such as glutamate,
dopamine, and GABA.
One study used 18F-FCWAY, a selective 5-HT1A
receptor antagonist, to study the receptor in
patients with TLE and demonstrated a reduced
serotonin receptor binding in temporal lobe
epileptic foci.
Imaging of Specific
Neurotransmitter Systems
42. Remember
Ictal SPECT is the only imaging modality that
can define in a reliable and consistent manner
the ictal onset zone.
The functional deficit zone is the part of the
cortex with an abnormal function in-between
seizures, due to morphological or functional
factors, or both.
Interictal FDG-PET is probably the best
imaging method to assess the functional deficit
zone.
44. It measures magnetic fields generated by
interictal electrical dipoles tangentially oriented
to the cortical surface.
This electrophysiologic data, when combined
with structural information from high-resolution
MRI, yields magnetic source imaging (MSI),
which helps in localizing the irritative zone
(and by inference, the epileptogenic zone)
Magnetoencephalography
(MEG)
45. Magnetic fields are found whenever there is a
current flow, whether in a wire or a neuronal
element.
The magnetic field passes unaffected through
brain tissue and the skull, so it can be
recorded outside the head .
By analyzing the spatial distributions of
magnetic fields it is possible to estimate the
intracranial localization of the generator source
and superimpose it on an MRI
Magnetoencephalography
(MEG)
46. In addition to defining the boundaries of the
epileptogenic zone, a common goal of the
presurgical evaluation of epilepsy patients is to
determine the spatial relationship of functional
cortex with the ictal focus, so as to anticipate
any potential deficits from a proposed
resection.
Magnetoencephalography
(MEG)
47. Magnetoencephalograp
hy (MEG) is a technique
for mapping brain
activity by recording
magnetic fields
produced by electrical
currents occurring
naturally in the brain,
using very sensitive
magnetometers.
Arrays of SQUIDs
(superconducting
quantum interference
devices) are currently
the most common
magnetometer.
Magnetoencephalography
(MEG)
48. Magnetoencephalography
(MEG)
Utility of MEG/MSI in localizing
a potential epileptogenic focus.
Axial MRI shows a gray
matter–lined cleft leading
toward the ventricle, typical of
closed-lip schizencephaly (left
panel).
The child had other suspected
areas of dysplastic cortex in
the left hemisphere. MEG/MSI
study demonstrating that the
predominance of interictal
abnormalities in this patient
localize to the area of the
schizencephaly (right panel).
49.
50. Threre is a-relationship between serum S100ß
protein (S100ßP), neuron specific enolase
(NSE) and heat shock protein 70 (HSP70) in
epilepsy syndrome .
Since HSP70, S100ßP, NSE, levels have
been shown to reflect central nervous system
damage, these biomarkers may be of
prognostic value in TLE patients from the
cognitive aspect.
Serological investigation in epilepsy
51. Elevated serum NSE has been reported in
patients with status epilepticus, complex
partial status, in addition to TLE.
serum S100ßP , NSE or HSP70 may be
useful biomarkers for central nervous system
damage. However, little data exists with
regards to these biomarkers and cognitive
performances in epilepsy.
Serological investigation in epilepsy
52. S 100 protein is a family of low molecular
weight protein found in vertebrates
S100B is glial-specific and is expressed
primarily by astrocytes.
This protein may function in neurite extension,
stimulation of Ca2+ fluxes and axonal
proliferation.
In the developing CNS it acts as a
neurotrophic factor and neuronal survival
protein.
Serological investigation in epilepsy
53. neuron specific enolase (NSE) is a
phosphopyruvate hydratase ,found in mature
neurons and cells of neuronal origin.
Heat shock proteins (HSPs) are a family of
constitutive and inducible molecular
chaperones that may possess anti-apoptotic
actions.
Induction of HSPs following seizures is long
reported, although their efficacy to block cell
death has only been recently addressed.
Serological investigation in epilepsy
54. serum levels of inflammatory cytokines,
interleukin-6 (IL-6) and interleukin-1 receptor
antagonist (IL-1RA) are significant elevated in
patien with TLE regardless duration of epilepsy
or mediction.
Serological investigation in epilepsy
56. The characteristic activities observed in the scalp
EEG of subjects with epilepsy are sharp transient
waveforms. Such transient waveforms include
spikes and sharp waves .
Importantly, demonstration of epileptiform
abnormalities in the EEG does not in itself equate
to epilepsy or indicate that the patient has a
seizure disorder.
Non-epileptic individuals show epileptiform
abnormalities in the EEG in a number of
circumstances.
57. Long-term monitoring (LTM)
There is now substantial evidence that LTM
has a crucial role in the assessment of seizure
disorders, as indicated by a recent ILAE
Commission report.
LTM methods comprise ambulatory and
video-EEG telemetry.
Ambulatory EEG is more suited to clinical
problems which do not require concurrent
synchronised video to document clinical
features (though it can be combined with
hand-held camcorder).
58. Methods to increase the likelihood of
paroxysmal events include reduction in dose
of anti-epileptic medication, sleep deprivation
and provocation techniques, such as saline
injections. However, the latter can result in
false positives, and there are ethical issues if
the patient is deliberately misled
Long-term monitoring (LTM)
59. Optimal duration of LTM study depends on the
clinical problem, and frequency of attacks.
Patients are unlikely to benefit from
monitoring if paroxysmal events occur less
than once per week.
Duration of outpatient LTM is to some extent
limited by technical issues – the need to
replace data storage media and batteries
every 24−48 hours, and the potential for faulty
recording due to poor electrode contact.
Long-term monitoring (LTM)
60. Neural networks
Neural networks and statistical pattern
recognition methods have been applied to
EEG analysis.
results showed that the ability of specifically
designed and trained recurrent neural
networks (RNN), combined with epileptic
wavelet preprocessing, to predict the onset of
seizures both on scalp and intracranial
recordings.
61. Basically, an artificial neural network is a
system. A system is a structure that receives
an input, process the data, and provides an
output.
Commonly, the input consists in a data array
which can be anything such as data from an
image file, a WAVE sound or any kind of data
that can be represented in an array.
Artificial neural Networks (ANN) have been
widely used for spike recognition.
Artificial neural networks
(ANNs)
63. TMS
A reduced MT ( motor threshold MT refers to the
lowest TMS intensity capable of eliciting small motor-
evoked potentials (MEPs), and is usually defined as
more than 50 micV in amplitude in muscles at rest or
200 micV in active muscles in at least five out of 10
trials ) indicating cortical hyperexcitability was
observed only in subsets of untreated patients with
idiopathic generalized epilepsy (IGE) .
In contrast, MT is usually increased in treated
patients with IGE or partial epilepsy, likely due to
antiepileptic treatment.
MT is also increased in the 48 h after a generalized
seizure .
64. TMS
Prolonged SP (single TMS pulses delivered
during voluntary muscle contraction produce a
period of EMG suppression known as the
silent period ) was reported in patients with
untreated IGE and in patients with partial
motor seizures, whether the lesion was
located within or outside the primary motor
cortex .
These findings may be due to spread of
epileptic hyperexcitability to corticospinal
inhibitory networks.
65.
66. Invasive Intracranial Monitoring
situations in which invasive intracranial
monitoring may be required:
Seizures are lateralized but not localized.
Seizures are localized but not lateralized .
Seizures are neither localized nor lateralized .
Seizure localization is discordant with other data (eg,
EEG ictal scalp data are discordant with
neuroimaging.
The relation of seizure onset to functional tissue must
be determined (eg, seizures with early involvement of
language or motor function).
The relation of seizure onset to lesion must be
determined (eg, dual pathology or multiple intracranial
lesions).
67. Depth, strip, and grid electrodes are
implantable intracranial devices used to record
the ECoG over an longer period and to
stimulate the cortex to determine function.
Invasive Intracranial Monitoring
68. The number of seizures required to consider
an intracranial study complete depends on the
specific issues involved with treating a
particular patient.
In general, an arbitrary number of 3 typical
clinical seizures has been considered the
minimum number to be captured.
Invasive Intracranial Monitoring
69. in addition to defining the location of the
epileptogenic cortex, the surgeon must determine
its relationship to functional cortex. This requires
mapping the cortex underlying an implanted grid
electrode.
During brain stimulation, brain mapping is
performed by a neuropsychologist or physician,
who may test language or motor function. A
clinical neurophysiologist reviews the ECoG
during stimulation to ensure that any disruption of
neurological function is due to the stimulation and
not an after discharge.
Invasive Intracranial Monitoring
70. Primary motor cortex is
located with use of
extraoperative
somatosensory evoked
potentials and
intraoperative cortical
stimulation, Penfield
instrument in field is
positioned over primary
motor cortex.
Invasive Intracranial Monitoring