WMHs is the most frequent type of CSVDs and a common incidental finding in MRI films of up to 70% of MRI images in individuals > 60 years, and 90% in those > 70 years.
Meticulous assessment of asymptomatic WMHs subjects reveals the presence of subtler cognitive, gait, balance and psychiatric disturbances.
Tips, Pearls and Pitfalls of Spinal Cord MRIWafik Bahnasy
- Many neurological disorders simultaneously or consecutively affect the brain and spinal cord, however most neurologist find their comfort zone in attending the diagnosis via the brain access.
- This concept resulted in lagging of spinal cord imaging researches compared to brain ones and consecutive underestimation of the opportunity of an important tool sometimes essential to reach a definite diagnosis.
Presentation1.pptx, radiological imaging of peri natal acute ischemia and hyp...Abdellah Nazeer
This document discusses radiological imaging of neonatal acute ischemia and hypoxic ischemic encephalopathy. It describes different types of imaging techniques including CT, MRI, DWI, and ASL and how they can be used to identify areas of injury over time in neonates who experience a stroke. Risk factors for neonatal stroke are also reviewed. Imaging findings include restricted diffusion, cortical laminar necrosis, and reversal of gray-white matter attenuation on CT. MRI is useful for assessing injury to deep gray matter structures and cortical border zones.
This document summarizes the neuroradiology findings of central nervous system fungal infections. It describes the imaging appearance of common fungal infections like cryptococcosis, aspergillosis, mucormycosis, and candidiasis. Key findings include ring-enhancing lesions on MRI for abscesses, meningeal enhancement for meningitis, and restricted diffusion on DWI for early detection of fungal infections. Imaging plays an important role in the diagnosis and management of CNS fungal diseases.
Issues in radiological pathology: Radiological pathology of watershed infarct...Professor Yasser Metwally
The document discusses border zone or watershed infarcts, which occur at the junction between two main arterial territories and constitute approximately 10% of all brain infarcts. There are two types - external (cortical) and internal (subcortical). External infarcts are often embolic in nature while internal infarcts are mainly caused by hemodynamic compromise. Advanced imaging can help identify areas of low perfusion and distinguish the two types. The document then examines the classification, imaging appearance, causal mechanisms, and clinical course of both external and internal border zone infarcts in more detail.
- A 15-year-old female developed left-sided optic neuritis followed by transverse myelitis months later. MRI showed periventricular white matter changes atypical for multiple sclerosis.
- The patient was diagnosed with neuromyelitis optica (Devic's disease), a disorder characterized by inflammation of the optic nerve and spinal cord. It is identified by longitudinally extensive spinal cord lesions on MRI and seropositivity for neuromyelitis optica immunoglobulin G.
- Acute transverse myelitis is an inflammatory disorder of the spinal cord that can have various causes, including infections, autoimmune disorders, and neuromyelitis optica. It is characterized clinically by motor,
The document discusses degenerative diseases of the brain that can cause dementia or non-dementing disorders. It describes several major dementing degenerative diseases including Alzheimer's disease, dementia with Lewy bodies, and vascular dementias. Alzheimer's disease is characterized by amyloid plaques and neurofibrillary tangles leading to hippocampal and temporal lobe atrophy. Vascular dementia is caused by multiple infarcts visible as lesions on MRI. Non-dementing disorders discussed include Parkinson's disease, multiple system atrophy, and progressive supranuclear palsy. The document provides an overview of imaging and diagnostic features of these common neurodegenerative conditions.
A case of Neuromyelitis optica as a presenting manifestation of Systemic Lupu...Apollo Hospitals
Neuromyelitis optica (NMO) is a well characterised, autoimmune, clinicopathological syndrome, which is uncommon and occurs as an isolated entity. Unlike multiple sclerosis, in NMO, the autoimmunity is humorally mediated and the recent availability of Antiaquaporin antibody testing has increased the positive diagnosis of this condition. NMO can also occur in patients with established Systemic Lupus Erythematosis (SLE) who have multiple autoantibodies. The presence of Antiaquaporin antibody is specific for NMO and is seen in patients with SLE who develop inflammatory CNS disease. However, Neuromyelitis optica occurring as a presenting manifestation of SLE is extremely rare and we report one such case.
Tips, Pearls and Pitfalls of Spinal Cord MRIWafik Bahnasy
- Many neurological disorders simultaneously or consecutively affect the brain and spinal cord, however most neurologist find their comfort zone in attending the diagnosis via the brain access.
- This concept resulted in lagging of spinal cord imaging researches compared to brain ones and consecutive underestimation of the opportunity of an important tool sometimes essential to reach a definite diagnosis.
Presentation1.pptx, radiological imaging of peri natal acute ischemia and hyp...Abdellah Nazeer
This document discusses radiological imaging of neonatal acute ischemia and hypoxic ischemic encephalopathy. It describes different types of imaging techniques including CT, MRI, DWI, and ASL and how they can be used to identify areas of injury over time in neonates who experience a stroke. Risk factors for neonatal stroke are also reviewed. Imaging findings include restricted diffusion, cortical laminar necrosis, and reversal of gray-white matter attenuation on CT. MRI is useful for assessing injury to deep gray matter structures and cortical border zones.
This document summarizes the neuroradiology findings of central nervous system fungal infections. It describes the imaging appearance of common fungal infections like cryptococcosis, aspergillosis, mucormycosis, and candidiasis. Key findings include ring-enhancing lesions on MRI for abscesses, meningeal enhancement for meningitis, and restricted diffusion on DWI for early detection of fungal infections. Imaging plays an important role in the diagnosis and management of CNS fungal diseases.
Issues in radiological pathology: Radiological pathology of watershed infarct...Professor Yasser Metwally
The document discusses border zone or watershed infarcts, which occur at the junction between two main arterial territories and constitute approximately 10% of all brain infarcts. There are two types - external (cortical) and internal (subcortical). External infarcts are often embolic in nature while internal infarcts are mainly caused by hemodynamic compromise. Advanced imaging can help identify areas of low perfusion and distinguish the two types. The document then examines the classification, imaging appearance, causal mechanisms, and clinical course of both external and internal border zone infarcts in more detail.
- A 15-year-old female developed left-sided optic neuritis followed by transverse myelitis months later. MRI showed periventricular white matter changes atypical for multiple sclerosis.
- The patient was diagnosed with neuromyelitis optica (Devic's disease), a disorder characterized by inflammation of the optic nerve and spinal cord. It is identified by longitudinally extensive spinal cord lesions on MRI and seropositivity for neuromyelitis optica immunoglobulin G.
- Acute transverse myelitis is an inflammatory disorder of the spinal cord that can have various causes, including infections, autoimmune disorders, and neuromyelitis optica. It is characterized clinically by motor,
The document discusses degenerative diseases of the brain that can cause dementia or non-dementing disorders. It describes several major dementing degenerative diseases including Alzheimer's disease, dementia with Lewy bodies, and vascular dementias. Alzheimer's disease is characterized by amyloid plaques and neurofibrillary tangles leading to hippocampal and temporal lobe atrophy. Vascular dementia is caused by multiple infarcts visible as lesions on MRI. Non-dementing disorders discussed include Parkinson's disease, multiple system atrophy, and progressive supranuclear palsy. The document provides an overview of imaging and diagnostic features of these common neurodegenerative conditions.
A case of Neuromyelitis optica as a presenting manifestation of Systemic Lupu...Apollo Hospitals
Neuromyelitis optica (NMO) is a well characterised, autoimmune, clinicopathological syndrome, which is uncommon and occurs as an isolated entity. Unlike multiple sclerosis, in NMO, the autoimmunity is humorally mediated and the recent availability of Antiaquaporin antibody testing has increased the positive diagnosis of this condition. NMO can also occur in patients with established Systemic Lupus Erythematosis (SLE) who have multiple autoantibodies. The presence of Antiaquaporin antibody is specific for NMO and is seen in patients with SLE who develop inflammatory CNS disease. However, Neuromyelitis optica occurring as a presenting manifestation of SLE is extremely rare and we report one such case.
This document provides an overview of neuromyelitis optica (NMO), including:
- The history of NMO and debates around whether it is a distinct disease or subtype of multiple sclerosis. Early case reports and reviews are discussed.
- Clinical features of NMO from case series, including most patients being women with average age of onset of 37, presentations involving optic neuritis, transverse myelitis or both, and courses being monophasic or polyphasic.
- Diagnostic criteria that have been proposed for NMO, including challenges given the variable clinical presentations and features that can overlap with other conditions.
Cerebral amyloid angiopathy (CAA) refers to the deposition of β-amyloid in the arteries of the cerebral cortex. It is commonly seen in Alzheimer's disease but can also occur in healthy elderly individuals. CAA can cause intracerebral hemorrhage, dementia, or transient neurological symptoms. The deposition damages blood vessels and increases the risk of hemorrhage. Imaging such as CT scans can detect hemorrhages characteristic of CAA, which are often lobar and cortical. Genetic factors like the ApoE genotype can influence the severity and presentation of CAA.
This document discusses cerebral haemorrhage (ICH), which accounts for 10-15% of strokes. ICH can result from several mechanisms, including hypertension (47-66% of cases), cerebral amyloid angiopathy (CAA), and vascular malformations. CAA typically affects the elderly and causes lobar ICH that is often recurrent or involves multiple simultaneous haemorrhages. Vascular malformations like arteriovenous malformations (AVMs) and cavernous angiomas are a common cause of ICH in young, non-hypertensive patients. Imaging techniques like CT and MRI can identify vascular malformations and help determine the underlying cause of ICH.
Endovascular Coil Embolization of Dissecting distal MCA Aneurysm with ICH in ...Dr. Shahnawaz Alam
This document discusses a case of a 12-year-old female patient who presented with sudden severe headache and loss of consciousness following a fall in the bathroom. Diagnostic imaging revealed a dissecting aneurysm of the middle cerebral artery (MCA). The patient underwent serial coil embolization of the aneurysm. The document discusses the treatment approach for dissecting MCA aneurysms and reviews similar cases reported in medical literature.
This document discusses optic pathway gliomas and hypothalamic gliomas. It begins by defining optic pathway gliomas as tumors confined to the precortical visual pathway, sometimes involving the hypothalamus. Their location makes them surgically challenging to manage, and the optimal management is controversial. The document then covers the epidemiology, pathology, clinical presentation, imaging, differential diagnosis, natural history, and management options for these tumors, which include observation, surgery, chemotherapy and radiotherapy. Management depends on factors like age, presence of NF1, tumor location and size, and symptoms.
This document discusses neuroimaging of cerebral ischemia. It describes how MRI can detect ischemia within minutes through diffusion imaging, which shows cytotoxic edema, and perfusion imaging, which shows reduced cerebral blood volume and prolonged mean transit time. Vasogenic edema appears later on T2-weighted MRI. Diffusion and perfusion imaging are recommended for evaluation of acute or early subacute ischemia, along with conventional MRI sequences. MRI is superior to CT for detection of cerebral ischemia, particularly within the first few days.
1. World Health Organization (WHO) grade 1 and 2 gliomas account for 60% of pediatric supratentorial tumors, with pilocytic astrocytomas being the most common, making up 1/3 of pediatric gliomas. Pilocytic astrocytomas have an excellent prognosis with 95% 10-year survival.
2. Diffuse astrocytomas are less common low-grade tumors in children. High-grade gliomas including anaplastic gliomas and glioblastomas are rare in children but have a poor prognosis, though survival is better than in adults.
3. Subependymal giant cell tumors are slow-growing tumors seen in children with tuberous s
Marfan syndrome is a genetic disorder of connective tissue caused by mutations in the FBN1 gene. It affects the skeletal, ocular, and cardiovascular systems. Key features include disproportionately long limbs, joint laxity, eye lens dislocation, and aortic root aneurysm/dissection which are the leading causes of mortality. Diagnosis is based on clinical criteria involving multiple organ systems. Ongoing monitoring of the aorta is critical as progressive dilatation can lead to dissection.
This document discusses various imaging modalities used to identify different cortical zones in epilepsy. It begins with an introduction to epilepsy and the role of neuroimaging. It then describes different cortical zones including the symptomatogenic zone, irritative zone, seizure onset zone, and epileptogenic zone. It discusses imaging techniques like CT, MRI sequences, SPECT, PET and fMRI and how they can help identify these zones. Specific conditions like mesial temporal lobe sclerosis, malformations of cortical development and focal cortical dysplasia are also covered. In summary, the document provides an overview of cortical zones in epilepsy and the various neuroimaging techniques used to identify and localize the epileptic focus.
Tolosa Hunt Syndrome is a rare idiopathic disease characterized by one or more episodes of unilateral orbital pain persisting for weeks if untreated, along with paresis of the third, fourth, and/or sixth cranial nerves. A granuloma may be seen on MRI or biopsy. The paresis coincides with or follows the pain within two weeks. Symptoms resolve within 72 hours when treated with steroids. Differential diagnoses include vascular causes, tumors, infections, and other inflammatory conditions. Treatment involves high-dose oral prednisone with other immunosuppressants if needed.
Presentation2, radiological imaging of neurodegenerative and dementai disease...Abdellah Nazeer
This document discusses radiological imaging techniques for diagnosing various neurodegenerative diseases and dementias. It provides an overview of different neurodegenerative diseases categorized by their underlying pathological processes including synucleinopathies, tauopathies, cerebral amyloidosis, spinocerebellar ataxias, and prion diseases. It then focuses on Alzheimer's disease, providing details on structural changes seen on MRI, patterns of hypometabolism on FDG-PET and amyloid deposition on amyloid PET. Imaging patterns of other diseases like vascular dementia, frontotemporal dementia, dementia with Lewy bodies, and corticobasal degeneration are also summarized.
Cerebral microbleeds are small brain hemorrhages detected by MRI that are caused by leakage of blood from damaged small vessel walls. They are increasingly recognized in patients with cerebrovascular disease, Alzheimer's disease, vascular cognitive impairment, and normal elderly populations. Microbleeds in lobar regions may indicate cerebral amyloid angiopathy and link vascular and amyloid neuropathologies, while deep or infratentorial microbleeds often reflect hypertensive vasculopathy. Detection of microbleeds provides insight into cerebral small vessel disease and its relationship to cognitive impairment and dementia.
- A 6-month-old male patient presented with macrocephaly, West syndrome, right-sided hemiplegia and severe developmental delay. MRI showed abnormal enlargement of the left cerebral hemisphere with signs of lissencephaly, pachygyria and heterotopias as well as white matter changes.
- The diagnosis was hemimegalencephaly, a rare congenital brain malformation where one hemisphere is abnormally enlarged. It involves neuronal and glial abnormalities and commonly causes seizures, hemiplegia and developmental delays.
- Hemimegalencephaly is characterized on imaging as asymmetric skull and brain enlargement, cortical dysplasias, and white matter signal changes correlated to poor
A 57-year-old male patient presented with left lower limb weakness that had progressed over three months. MRI images showed bilateral, symmetrical lesions in the posterior parieto-occipital white matter, which had scalloped margins and did not enhance or cause mass effect. Based on the clinical presentation and MRI findings, the patient was diagnosed with progressive multifocal leukoencephalopathy (PML), a demyelinating disease caused by JC virus reactivation that predominantly affects immunocompromised individuals. PML lesions are typically multifocal and located in the white matter of the brain, most often in the parieto-occipital region.
Spinal stroke is a rare type of stroke accounting for less than 1% of all strokes. It results from an acute disruption of blood supply to the spinal cord, causing ischemia and neurological deficits. The spinal cord receives its blood supply from the anterior spinal artery and dual posterior spinal arteries. Etiologies of spinal stroke include vertebral artery dissection, arteriosclerosis, embolism, hypotension, and vasculitis. Clinical features appear rapidly within 30-45 minutes and include radicular pain and neurological deficits depending on the affected territory. MRI is important for diagnosis, particularly vertebral body infarction. There is no established effective therapy, but prognosis varies with age and severity, with many patients experiencing some improvement over time.
This document discusses various radiological manifestations of cerebral tuberculosis. It describes that approximately 10% of tuberculosis patients have central nervous system involvement. Imaging plays an important role in the diagnosis and evaluation of various intracranial manifestations of tuberculosis including tuberculous meningitis, tuberculoma, miliary tuberculosis, tuberculous encephalopathy and others. Characteristic radiological findings of each condition are outlined along with recommendations for appropriate imaging modalities. Spinal tuberculosis is also discussed with descriptions of typical radiographic and MRI findings.
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.
A 12-year-old female patient presented with left-sided focal motor seizures since age 4. She developed progressive left-sided weakness and intellectual impairment. Brain imaging showed prominent right hemispheric atrophy. The diagnosis was Rasmussen's encephalitis. The document provides information on accessing updated case publications and related resources through the editor's website.
The study investigated the relationship between dilated Virchow-Robin spaces (VRS) seen on MRI and cerebral microvascular disease in elderly patients with dementia. 75 patients with Alzheimer's disease, ischemic vascular dementia, or frontotemporal dementia underwent MRI and were compared to 35 healthy volunteers. VRS scores were significantly higher in patients with vascular dementia compared to those with Alzheimer's disease, frontotemporal dementia, or healthy volunteers. VRS scores accounted for 29% of the variance in a regression model, more than periventricular hyperintensities, suggesting dilated VRS are a sensitive indicator of cerebral microvascular disease.
Hematoma expansion after spontaneous intracerebral hemorrhageWafik Bahnasy
The size of the hematoma grows due to rebleeding in the next few hours after the onset in up to 40% of cases which results in early neurological deterioration, poor functional outcome and increased mortality.
This document provides an overview of neuromyelitis optica (NMO), including:
- The history of NMO and debates around whether it is a distinct disease or subtype of multiple sclerosis. Early case reports and reviews are discussed.
- Clinical features of NMO from case series, including most patients being women with average age of onset of 37, presentations involving optic neuritis, transverse myelitis or both, and courses being monophasic or polyphasic.
- Diagnostic criteria that have been proposed for NMO, including challenges given the variable clinical presentations and features that can overlap with other conditions.
Cerebral amyloid angiopathy (CAA) refers to the deposition of β-amyloid in the arteries of the cerebral cortex. It is commonly seen in Alzheimer's disease but can also occur in healthy elderly individuals. CAA can cause intracerebral hemorrhage, dementia, or transient neurological symptoms. The deposition damages blood vessels and increases the risk of hemorrhage. Imaging such as CT scans can detect hemorrhages characteristic of CAA, which are often lobar and cortical. Genetic factors like the ApoE genotype can influence the severity and presentation of CAA.
This document discusses cerebral haemorrhage (ICH), which accounts for 10-15% of strokes. ICH can result from several mechanisms, including hypertension (47-66% of cases), cerebral amyloid angiopathy (CAA), and vascular malformations. CAA typically affects the elderly and causes lobar ICH that is often recurrent or involves multiple simultaneous haemorrhages. Vascular malformations like arteriovenous malformations (AVMs) and cavernous angiomas are a common cause of ICH in young, non-hypertensive patients. Imaging techniques like CT and MRI can identify vascular malformations and help determine the underlying cause of ICH.
Endovascular Coil Embolization of Dissecting distal MCA Aneurysm with ICH in ...Dr. Shahnawaz Alam
This document discusses a case of a 12-year-old female patient who presented with sudden severe headache and loss of consciousness following a fall in the bathroom. Diagnostic imaging revealed a dissecting aneurysm of the middle cerebral artery (MCA). The patient underwent serial coil embolization of the aneurysm. The document discusses the treatment approach for dissecting MCA aneurysms and reviews similar cases reported in medical literature.
This document discusses optic pathway gliomas and hypothalamic gliomas. It begins by defining optic pathway gliomas as tumors confined to the precortical visual pathway, sometimes involving the hypothalamus. Their location makes them surgically challenging to manage, and the optimal management is controversial. The document then covers the epidemiology, pathology, clinical presentation, imaging, differential diagnosis, natural history, and management options for these tumors, which include observation, surgery, chemotherapy and radiotherapy. Management depends on factors like age, presence of NF1, tumor location and size, and symptoms.
This document discusses neuroimaging of cerebral ischemia. It describes how MRI can detect ischemia within minutes through diffusion imaging, which shows cytotoxic edema, and perfusion imaging, which shows reduced cerebral blood volume and prolonged mean transit time. Vasogenic edema appears later on T2-weighted MRI. Diffusion and perfusion imaging are recommended for evaluation of acute or early subacute ischemia, along with conventional MRI sequences. MRI is superior to CT for detection of cerebral ischemia, particularly within the first few days.
1. World Health Organization (WHO) grade 1 and 2 gliomas account for 60% of pediatric supratentorial tumors, with pilocytic astrocytomas being the most common, making up 1/3 of pediatric gliomas. Pilocytic astrocytomas have an excellent prognosis with 95% 10-year survival.
2. Diffuse astrocytomas are less common low-grade tumors in children. High-grade gliomas including anaplastic gliomas and glioblastomas are rare in children but have a poor prognosis, though survival is better than in adults.
3. Subependymal giant cell tumors are slow-growing tumors seen in children with tuberous s
Marfan syndrome is a genetic disorder of connective tissue caused by mutations in the FBN1 gene. It affects the skeletal, ocular, and cardiovascular systems. Key features include disproportionately long limbs, joint laxity, eye lens dislocation, and aortic root aneurysm/dissection which are the leading causes of mortality. Diagnosis is based on clinical criteria involving multiple organ systems. Ongoing monitoring of the aorta is critical as progressive dilatation can lead to dissection.
This document discusses various imaging modalities used to identify different cortical zones in epilepsy. It begins with an introduction to epilepsy and the role of neuroimaging. It then describes different cortical zones including the symptomatogenic zone, irritative zone, seizure onset zone, and epileptogenic zone. It discusses imaging techniques like CT, MRI sequences, SPECT, PET and fMRI and how they can help identify these zones. Specific conditions like mesial temporal lobe sclerosis, malformations of cortical development and focal cortical dysplasia are also covered. In summary, the document provides an overview of cortical zones in epilepsy and the various neuroimaging techniques used to identify and localize the epileptic focus.
Tolosa Hunt Syndrome is a rare idiopathic disease characterized by one or more episodes of unilateral orbital pain persisting for weeks if untreated, along with paresis of the third, fourth, and/or sixth cranial nerves. A granuloma may be seen on MRI or biopsy. The paresis coincides with or follows the pain within two weeks. Symptoms resolve within 72 hours when treated with steroids. Differential diagnoses include vascular causes, tumors, infections, and other inflammatory conditions. Treatment involves high-dose oral prednisone with other immunosuppressants if needed.
Presentation2, radiological imaging of neurodegenerative and dementai disease...Abdellah Nazeer
This document discusses radiological imaging techniques for diagnosing various neurodegenerative diseases and dementias. It provides an overview of different neurodegenerative diseases categorized by their underlying pathological processes including synucleinopathies, tauopathies, cerebral amyloidosis, spinocerebellar ataxias, and prion diseases. It then focuses on Alzheimer's disease, providing details on structural changes seen on MRI, patterns of hypometabolism on FDG-PET and amyloid deposition on amyloid PET. Imaging patterns of other diseases like vascular dementia, frontotemporal dementia, dementia with Lewy bodies, and corticobasal degeneration are also summarized.
Cerebral microbleeds are small brain hemorrhages detected by MRI that are caused by leakage of blood from damaged small vessel walls. They are increasingly recognized in patients with cerebrovascular disease, Alzheimer's disease, vascular cognitive impairment, and normal elderly populations. Microbleeds in lobar regions may indicate cerebral amyloid angiopathy and link vascular and amyloid neuropathologies, while deep or infratentorial microbleeds often reflect hypertensive vasculopathy. Detection of microbleeds provides insight into cerebral small vessel disease and its relationship to cognitive impairment and dementia.
- A 6-month-old male patient presented with macrocephaly, West syndrome, right-sided hemiplegia and severe developmental delay. MRI showed abnormal enlargement of the left cerebral hemisphere with signs of lissencephaly, pachygyria and heterotopias as well as white matter changes.
- The diagnosis was hemimegalencephaly, a rare congenital brain malformation where one hemisphere is abnormally enlarged. It involves neuronal and glial abnormalities and commonly causes seizures, hemiplegia and developmental delays.
- Hemimegalencephaly is characterized on imaging as asymmetric skull and brain enlargement, cortical dysplasias, and white matter signal changes correlated to poor
A 57-year-old male patient presented with left lower limb weakness that had progressed over three months. MRI images showed bilateral, symmetrical lesions in the posterior parieto-occipital white matter, which had scalloped margins and did not enhance or cause mass effect. Based on the clinical presentation and MRI findings, the patient was diagnosed with progressive multifocal leukoencephalopathy (PML), a demyelinating disease caused by JC virus reactivation that predominantly affects immunocompromised individuals. PML lesions are typically multifocal and located in the white matter of the brain, most often in the parieto-occipital region.
Spinal stroke is a rare type of stroke accounting for less than 1% of all strokes. It results from an acute disruption of blood supply to the spinal cord, causing ischemia and neurological deficits. The spinal cord receives its blood supply from the anterior spinal artery and dual posterior spinal arteries. Etiologies of spinal stroke include vertebral artery dissection, arteriosclerosis, embolism, hypotension, and vasculitis. Clinical features appear rapidly within 30-45 minutes and include radicular pain and neurological deficits depending on the affected territory. MRI is important for diagnosis, particularly vertebral body infarction. There is no established effective therapy, but prognosis varies with age and severity, with many patients experiencing some improvement over time.
This document discusses various radiological manifestations of cerebral tuberculosis. It describes that approximately 10% of tuberculosis patients have central nervous system involvement. Imaging plays an important role in the diagnosis and evaluation of various intracranial manifestations of tuberculosis including tuberculous meningitis, tuberculoma, miliary tuberculosis, tuberculous encephalopathy and others. Characteristic radiological findings of each condition are outlined along with recommendations for appropriate imaging modalities. Spinal tuberculosis is also discussed with descriptions of typical radiographic and MRI findings.
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.
A 12-year-old female patient presented with left-sided focal motor seizures since age 4. She developed progressive left-sided weakness and intellectual impairment. Brain imaging showed prominent right hemispheric atrophy. The diagnosis was Rasmussen's encephalitis. The document provides information on accessing updated case publications and related resources through the editor's website.
The study investigated the relationship between dilated Virchow-Robin spaces (VRS) seen on MRI and cerebral microvascular disease in elderly patients with dementia. 75 patients with Alzheimer's disease, ischemic vascular dementia, or frontotemporal dementia underwent MRI and were compared to 35 healthy volunteers. VRS scores were significantly higher in patients with vascular dementia compared to those with Alzheimer's disease, frontotemporal dementia, or healthy volunteers. VRS scores accounted for 29% of the variance in a regression model, more than periventricular hyperintensities, suggesting dilated VRS are a sensitive indicator of cerebral microvascular disease.
Hematoma expansion after spontaneous intracerebral hemorrhageWafik Bahnasy
The size of the hematoma grows due to rebleeding in the next few hours after the onset in up to 40% of cases which results in early neurological deterioration, poor functional outcome and increased mortality.
1. The document discusses Chronic Cerebrospinal Venous Insufficiency (CCSVI), a condition linked to multiple sclerosis (MS) where veins draining the brain and spinal cord are narrowed or blocked.
2. It provides details on diagnosing and treating CCSVI using procedures like Doppler ultrasound, MRI, venography, and venous angioplasty to widen blocked veins.
3. While the relationship between CCSVI and MS is still being studied, the document reports that over 600 MS patients treated for CCSVI experienced reduced fatigue, improved quality of life, psychological state, and physical condition based on evaluation scales.
Vasculitis refers to inflammation of blood vessels. It is classified based on vessel size and pathology. The most common pediatric vasculitides are Henoch-Schonlein purpura and Kawasaki disease. Diagnosis involves evaluating symptoms, radiology like angiograms, histopathology of biopsied tissues, and serology tests like ANCA. Treatment depends on type and severity of vasculitis. Prognosis varies, with most children recovering fully from HSP or KD, while other types like AAV carry higher risks of organ damage and mortality if not properly treated.
Antihyperglycemic agents. The term "biguanidine" often refers specifically to a class of drugs that function as oral antihyperglycemic drugs used for diabetes mellitus or prediabetes treatment. Examples include: Metformin - widely used in treatment of diabetes mellitus type 2.
This document summarizes the case of a 67-year-old woman presenting with chronic headache and right-sided weakness. Imaging revealed a heterogeneous mass centered in the splenium of the corpus callosum, with significant edema. The differential diagnosis includes glioblastoma, lymphoma, metastasis, demyelination, and toxoplasmosis. Histopathology found features consistent with glioblastoma such as cellular atypia, necrosis, endothelial proliferation, and GFAP positivity.
This patient presented with chronic headache and right-sided weakness. Imaging revealed a heterogeneous mass centered in the splenium of the corpus callosum, with significant edema. Histopathology of a biopsy showed features of a high-grade glioma such as cellular atypia, endothelial proliferation, and a high Ki-67 proliferation index. Immunohistochemistry was positive for GFAP. Features were consistent with glioblastoma multiforme.
A 32-year-old male presented with a single grand mal seizure. CT scans showed extradural masses in the left parietal and frontal regions, compressing the brain and ventricles. Surgery revealed nodular dural thickening without brain infiltration. Biopsy diagnosed non-Hodgkin B-cell lymphoma. Further staging found extensive extraneural disease, though the CNS manifestations were the initial presentation. The patient was referred for oncology management for epidural secondary CNS lymphoma.
A 25-year-old man presented with seizures and was found to have neurocysticercosis based on imaging findings. MRI showed multiple hypo-intense brain lesions on T1W and FLAIR sequences that were hyper-intense on T2WI, with a central nodule in each lesion. He was treated with albendazole and a VP shunt was placed for associated hydrocephalus. Follow-up imaging showed decreased lesion size and resolution of hydrocephalus. Neurocysticercosis results from Taenia solium infection and can cause seizures, hydrocephalus, and other neurological symptoms.
This document discusses opportunities for using nanomedicine to address cardiovascular diseases. Specifically, it proposes using perfluorocarbon nanoparticles targeted with ligands to noninvasively assess and treat atherosclerosis in asymptomatic patients. The nanoparticles could detect plaque neovasculature using MRI to identify vulnerable lesions. They could also locally deliver antiangiogenic drugs at much lower doses than systemic treatments to reduce plaque progression. Preliminary studies in rabbits found targeted fumagillin nanoparticles significantly reduced integrin expression, indicating reduced angiogenesis, after one week.
Brain metastasis is an advance diseases with poor overall prognosis management of which is full of controversies. This slide aims to make metastasis simplified.
Medical imaging practice, diagnosis, symptoms and treatment for Cerebral Cavernous Malformation, written, edited and reviewed by Dr Walif Chbeir. Images can be found on WalifChbeir.net.
This study examined microvascular proliferation (MVP) in neuroblastoma tumors to determine its clinical significance. MVP, including glomeruloid MVP, was significantly associated with poor prognosis in two independent cohorts of neuroblastoma patients. MVP was also significantly associated with the clinically aggressive Schwannian stroma-poor histology of neuroblastomas. These findings provide further evidence that angiogenesis plays an important role in neuroblastoma pathogenesis and behavior, and suggest angiogenesis is regulated differently depending on the amount of Schwannian stroma in the tumor.
TUBEROUS SCLEROSIS
Cutaneous Features
Neurological Features
Retinal Features
Systemic Features
NEUROFIBROMATOSIS
Cutaneous Features of Neurofibromatosis Type 1
Systemic Features of Neurofibromatosis Type 1
Neurological Features in Neurofibromatosis Type 1
Clinical Features of Neurofibromatosis Type 2
STURGE-WEBER SYNDROME
Cutaneous Features
Ocular Features
Neurological Features
Diagnostic Studies
Treatment
VON HIPPEL-LINDAU SYNDROME
Neurological Features
Ocular Features
Systemic Features
Molecular Genetics
Treatment
HEREDITARY HEMORRHAGIC TELANGIECTASIA
Neurological Features
Treatment
HYPOMELANOSIS OF ITO
Cutaneous Features
Neurological Features
Systemic Features
INCONTINENTIA PIGMENTI
Cutaneous Features
Neurological Features
Genetics
ATAXIA-TELANGIECTASIA
Cutaneous Features
Neurological Features
Immunodeficiency and Cancer Risk
Laboratory Diagnosis
EPIDERMAL NEVUS SYNDROME
Cutaneous Features
Neurological Features
Other Features
Neuroimaging
NEUROCUTANEOUS MELANOSIS
Cutaneous Features
Neurological Features
Laboratory Findings
Neuroimaging
EHLERS-DANLOS SYNDROME
Neurovascular Features
CEREBROTENDINOUS XANTHOMATOSIS
Neurological Features
Xanthomas
Other Clinical Features
Treatment
PROGRESSIVE FACIAL HEMIATROPHY
Clinical Features
KINKY HAIR SYNDROME (MENKES DISEASE)
Cutaneous Features
Other Clinical Features
Neurological Features
Neuroimaging
Genetic Studies
Diagnosis and Treatment
XERODERMA PIGMENTOSUM
Complementation Groups
Related Syndromes
Cutaneous and Ocular Features
Treatment
OTHER NEUROLOGICAL CONDITIONS WITH CUTANEOUS
MANIFESTATIONS
1) Brain metastases are a common consequence of systemic cancer that spreads via hematogenous spread, most often originating from the lung, breast, skin (melanoma), kidney, or colon.
2) Treatment options include surgical resection to reduce symptoms from mass effect, whole brain radiation therapy to control multiple metastases, and stereotactic radiosurgery for limited metastases.
3) Patient prognosis depends on factors like age, functional status, extent of primary cancer, and number/size of brain metastases, with standardized grading systems used to assess survival outcomes.
1) The natural history of unruptured intracranial aneurysms and factors that influence treatment decisions are complex, depending on aneurysm characteristics like size and location as well as patient factors.
2) Treatment aims to completely occlude aneurysms while preserving neurological function, but options must be carefully considered based on individual patient and aneurysm assessment.
3) Scoring systems can help quantify rupture risk to inform whether conservative management or treatment is most appropriate, though ultimate decisions require multidisciplinary evaluation and discussion with the patient.
The document provides information on pilocytic astrocytomas including:
- Pilocytic astrocytomas most commonly occur in the cerebellum in children between 5-15 years old. They present as well-circumscribed yet non-encapsulated masses that are often cystic with a projecting nodule.
- Microscopically, they have a biphasic pattern of dense, elongated astrocytes alternating with loose, microcystic regions. They frequently contain Rosenthal fibers and abnormal, thick-walled blood vessels.
- Pilocytic astrocytomas are considered low-grade tumors that grow slowly by expansion rather than infiltration. They have a benign
Primary central nervous system vasculitis (PACNS) is a rare disorder characterized by inflammation of blood vessels in the brain and spinal cord. It presents with non-specific symptoms like headache, cognitive impairment, and focal neurological deficits. Diagnosis involves neuroimaging showing multifocal lesions, angiography revealing vessel narrowing and dilation, and brain biopsy detecting immune cell infiltration of vessel walls. While the cause is unknown, infectious agents may trigger PACNS. Treatment involves immunosuppression but prognosis depends on disease severity and response to treatment.
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.
Similar to White matter hyperintensities, the invisible invader (20)
Idiopathic intracranial hypertension, Looking for the black cat in the dark r...Wafik Bahnasy
IIH is a disorder characterized by elevation of the ICP
without evidences of CSF cytochemical alterations,
dilated ventricles or mass lesions
◘ The annual incidence of IIH is increasing in association
with higher obesity rates, whereas recent scientific
studies indicate a possible role for androgen sex
hormones and adipose tissue in the pathogenesis of
the disease
True vs. pseudo papilledema, Dr. Jekyll and Mr. HydeWafik Bahnasy
◘ The term “ has been restricted to the description of optic disc swelling secondary to increased ICP
◘ Papilledema is the hallmark sign of IIH with or without associated retinal hemorrhages, folds, cotton wool spots, and exudates
◘ Papilledema results in dysfunction of the swollen ON fibers followed by progressive loss of the retinal nerve fibers, and lastly optic atrophy
◘ The threat of vision loss is correlated with the severity of papilledema
Controversies in Tremor disorder, Beyound the resting and kinetic oscillationsWafik Bahnasy
(1) Tremor type identification is not always an easy mission.
(2) Always revise your initial diagnosis.
(3) Be flexible and able to change your initial diagnosis on the basis of new findings, manner of disease progression and response to treatment
This document discusses several topics related to women with epilepsy (WWE), including:
1. WWE have faced social stigma and legal restrictions on marriage and pregnancy in the past. Some challenges still remain today.
2. Seizures and antiepileptic drugs can disrupt the hormonal system and affect sexual function and fertility in WWE. This poses challenges for planning and having healthy pregnancies.
3. Pregnancies in WWE require careful management to minimize risks to the health of the mother and fetus from seizures and effects of antiepileptic drugs. Close monitoring is needed before, during, and after pregnancy.
Refractory Status epilepticus: A Time TravelWafik Bahnasy
Status Epilepticus is a condition resulting from failure of the mechanisms responsible for seizure termination or the initiation of mechanisms, which leads to abnormally prolonged seizures (time point, T1) that might have long-term consequences (time point T2), including neuronal death, neuronal injury, and alteration of neuronal networks, depending on the type and duration of seizures.
Neuromyelitis optica spectrum disorders (NMOSD) is an autoimmune disorder of young adults' results from astrocytic aquaporin–4 (AQP–4) channelopathy. The AQP–4 IgG antibodies may be present in the context of some paraneoplastic disorders which should be suspected when NMOSD occurs in elderly patients.
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This document discusses acute ischemic stroke (AIS) management. It notes that AIS is caused by focal cerebral, spinal or retinal infarction. It highlights the importance of rapid identification, stabilization, and transport to a certified stroke center to reduce treatment delays. For thrombolysis to be effective, it must be administered within 4.5 hours of symptom onset. The document outlines evaluation and treatment protocols for AIS patients in the pre-hospital and emergency department settings. Overall, it emphasizes minimizing time delays to improve outcomes through coordinated systems of stroke care.
This study aimed to investigate etiological factors of primary monosymptomatic nocturnal enuresis (MNE) in children. The study assessed 40 children with MNE and 20 healthy controls matched for age and sex. Assessments included history, examinations, sleep studies, vasopressin levels, and psychological evaluations. Results showed children with MNE had higher vasopressin levels at night compared to day, lower REM sleep, and more sleep stage transitions. They also showed more anxiety, social problems, and attention issues. Frequency of bedwetting was associated with these sleep and psychological abnormalities. The study identified multiple etiological factors involved in MNE and heterogeneity among cases.
Sleep abnormalities in Gullian Barre Syndrome PatientsWafik Bahnasy
GBS had long been defined as a neurological disorder with various sensori-motor manifestations with little attention to its psychiatric and sleep manifestations.
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(1) The document discusses various components and parameters measured in a polysomnogram (PSG), including EEG, respiratory effort, airflow, oxygen saturation, EOG, EMG, ECG, and limb movements.
(2) Key parts of a PSG include distinguishing between sleep stages like N1, N2, N3, and REM sleep based on EEG patterns, eye movements, and muscle tone. Parameters like sleep latency, sleep efficiency, and arousal index are also calculated.
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(2) TMS has diagnostic applications for mapping motor areas before surgery and assessing motor conduction, as well as therapeutic uses for treating depression, migraines, and movement disorders.
(3) Side effects are generally mild but may include scalp pain or discomfort at the site of stimulation. TMS is considered safe when used as recommended.
This document discusses cognition, dementia, and Alzheimer's disease (AD). It provides details on:
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Physiological reduction of the gonadal sex hormones in old ages results in declined neurogenesis especially in the hippocampus with the resultant age dependent memory and executive functions regressions.
Physiological reduction of the gonadal sex hormones in old ages results in declined neurogenesis especially in the hippocampus with the resultant age dependent cognitive impairment and risk of AD
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- Video recording of this lecture in English language: https://youtu.be/kqbnxVAZs-0
- Video recording of this lecture in Arabic language: https://youtu.be/SINlygW1Mpc
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
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
TEST BANK For An Introduction to Brain and Behavior, 7th Edition by Bryan Kol...rightmanforbloodline
TEST BANK For An Introduction to Brain and Behavior, 7th Edition by Bryan Kolb, Ian Q. Whishaw, Verified Chapters 1 - 16, Complete Newest Versio
TEST BANK For An Introduction to Brain and Behavior, 7th Edition by Bryan Kolb, Ian Q. Whishaw, Verified Chapters 1 - 16, Complete Newest Version
TEST BANK For An Introduction to Brain and Behavior, 7th Edition by Bryan Kolb, Ian Q. Whishaw, Verified Chapters 1 - 16, Complete Newest Version
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.
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The UK is currently facing a Adhd Medication Shortage Uk, which has left many patients and their families grappling with uncertainty and frustration. ADHD, or Attention Deficit Hyperactivity Disorder, is a chronic condition that requires consistent medication to manage effectively. This shortage has highlighted the critical role these medications play in the daily lives of those affected by ADHD. Contact : +1 (747) 209 – 3649 E-mail : sales@trinexpharmacy.com
These lecture slides, by Dr Sidra Arshad, offer a quick overview of the physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar lead (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
6. Describe the flow of current around the heart during the cardiac cycle
7. Discuss the placement and polarity of the leads of electrocardiograph
8. Describe the normal electrocardiograms recorded from the limb leads and explain the physiological basis of the different records that are obtained
9. Define mean electrical vector (axis) of the heart and give the normal range
10. Define the mean QRS vector
11. Describe the axes of leads (hexagonal reference system)
12. Comprehend the vectorial analysis of the normal ECG
13. Determine the mean electrical axis of the ventricular QRS and appreciate the mean axis deviation
14. Explain the concepts of current of injury, J point, and their significance
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. Chapter 3, Cardiology Explained, https://www.ncbi.nlm.nih.gov/books/NBK2214/
7. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
White matter hyperintensities, the invisible invader
1.
2.
3.
4. ◘ MAS is a 67 year old male, not HTN, DM, IHD or
dyslipidemia.
◘ He was presented by acute right hemiparesis due
to left capsular infarction.
◘ MRI showed extensive CSVDs (WMHs, DPVs).
◘ Poststroke, the patient suffered marked delay in
gait rehabilitation and repeated falls compared
to his age matched counterparts.
(1)Whatis therelationbetweenWMHsanddelayedfunctionalrecovery?
(2)CouldWMHsbe considereda strokerisk?
5. ◘ CSVD is an umbrella term that describes a Group of Neuroimaging and Neuropathological Changes in the white matter and subcortical grey
matterresultsfromstructuraland/orfunctionalabnormalitiesoftheperforating arteries,capillaries and venules.
◘ CSVDinoldconsistsof 2 maintype;CAAandhypertensivearteriopathy.
6.
7. ◘ Visual rating assessment revealed non-significant differences in topographic distribution of WMHs related to CAA or hypertensive
arteriopathy.
◘ AutomatedWMHsanalysisshowedthat:
(1)MultiplesubcorticalspotpatternandmoreparietalWMHsdistributionis goingwithCAA.
(2)Peri-basalgangliaWMHspatternis stronglylinkedto hypertensivearteriopathy.
8. ◘ WMHs of presumed vascular origin are defined as areas of
aberrant white matter appearance with increased
intensity in T2WI and FLAIR images:
(1) Away from areas of cortical lesions or ventricular
enlargement.
(2) Not related to demyelinating disease, leukodystrophy or
other nonvascular causes.
◘ WMHs is the most frequent type of CSVDs and a common
incidental finding in MRI films of up to 70% of MRI
images in individuals > 60 years, and 90% in those > 70
years.
9. ◘ More than 50 terms are used in literatures to describe WMHs including Binswanger disease, leukoaraiosis, age related white matter changes,
incidentalwhitematterlesions,leukoencephalopathy,subcorticalhyperintensitiesandsmallvesselischemicdisease.
10. ◘ Till a recent time, WMHs are considered as
incidental age-related imaging findings with little
attention paid to their clinical implications and
spectrum of their benign range.
◘ Meticulous assessment of asymptomatic WMHs
subjects reveals the presence of subtler cognitive,
gait, balance and psychiatric disturbances.
13. (1) Periventricular WMHs:
(i) grade 0: no WMHs.
(ii) grade 1: caps or pencil-thin lining.
(iii) grade 2: smooth halo.
(iv) grade 3: irregular periventricular WMH
extending into the deep white matter.
(2) Deep Subcortical WMHs:
(i) grade 0: no WMHs.
(ii) grade 1: punctuate foci.
(iii) grade 2: beginning confluence of foci.
(iv) grade 3: large confluent areas.
◘ Visual rating scales as the Fazekas, CREDOS or the ARWMC provide semi-quantitative assessments of WMHs burden but subjected to high inter-
ratervariabilities.
14. ◘ Several automated WMHs quantification have been proposed e.g. Medical Imaging Processing, Analysis, and Visualization, UBO, fully automated
WMHsdetector.
◘ ThesemethodsallowintegratedWMHsvolumelesionsinstrategictracts.(34)
UBO, fully automated WMHs
detector
15.
16. ◘ The pathogenesis of WMHs is a combination of endothelial dysfunction, inflammation, increased vascular permeability, BBB disruption and
venousinsufficiency.
◘ Thenet resultsareperivascularischemicinjury,demyelinationandglialscarring.
17. ◘ Endothelial dysfunction is one of the leading
etiological causes of WMHs through variable
mechanisms;
(1) Cerebral hypoperfusion secondary to reduction of
nitric oxide signaling.
(2) Leakage of inflammatory mediators into the blood
vessel wall and perivascular spaces.
(3) Blockage of oligodendrocyte precursor cell
maturation, to mature oligodendrocyte with
consecutive impairment in axonal myelin repair.
18. ◘ Many studies revealed increased vascular resistance is a
major contributor of WMHs pathogenesis.
◘ Perforating arterial wall stiffness is could be identified
by luminal stenosis, tortuosity, focal dilatation and
increased intracranial pulsatility.
◘ Microangiopathy results in impaired cerebral
autoregulation with consecutive sluggish vascular
reactivity in response to increased neuronal activity
or breathing of 6% CO2 in inspired air.
◘ 7–T MRA showing (a) normal
perforators, (b) highly tortuous
lenticulostriate arteries in a patient
with WMHs.
19. ◘ Astrocytic dysfunction results in perivascular leakage of CSF and inflammatory mediators to the blood vessel wall and perivascular
interstitial space.(14)
21. ◘ Some studies proposed some roles of gut microbiota and persistent systemic inflammation in middle-to late-life with the development of WMHs in
olderages.(14)
22. ◘ Significant increase in periventricular WMHs volume
was noticed in astronauts after long-duration
spaceflight but no changes were denoted regarding
deep WMHs.
◘ WMHs burden was significantly increased in high-
altitude U-2 pilots compared to age-matched healthy
controls with associated wide range of cognitive
impairments.
◘ This observation points to the role of CSF weightlessness
in the pathogenesis of periventricular WMHs.
(a) pre-flight and (b) post- flight
periventricular WMHs
23. ◘ The relation of WMHs and extra- or intra- cranial large arteries atherosclerosis is not well established, but most researchers consider it as an
associationratherthanconsequence.
24.
25. ◘ WMHs is a dynamic whole brain disorder with pathological changes not only in the WMHs lesions but also in the NAWM as well as the grey
matter.(3)
28. ◘ Decreased perfusion, BBB disruption as well as impaired micro-structural integrity of the NAWM surrounding WMHs in multimodal imaging
approaches(PET,xenon-CT,perfusionMRI)arepredictorsof theirfuturetransitionto WMHs.(15)
29. ◘ Refers to brainvolume lossadjacent to WMHsdue to cortical thinningandwhitematter shrinkageby gliosis.
◘ Periventricular
WMHs are
associated with
cortical thinning
than deep WMHs
with consecutive
more cognitive
dysfunction.(40)
30. ◘ 55-year-old patient with WMHs at baseline assessment with follow-up T1 scan shows clear sulcal widening, and ventricular enlargement.
(13)
31.
32. ◘ The human brain is the most complex network in the real
word which is composed of about 100 billion neurons
connected by 100 trillion synapses permitting highly
efficient and rapid information transmission.
◘ The graph theory is based on the connectome is the
structural as well as functional unit of the brain web
system.
◘ Each network is composed of nodes and edges where the
nodes represent functionally uniform neurons grouped
together while the edges represent meaningful
connections between pairs of nodes.
33. ◘ Represents anatomical associations among
different neuronal elements, based on white
matter fiber tracts' integrity
◘ Corresponds to the magnitudes of temporal
correlations in activity between pairs of
anatomically unconnected regions.
◘ The brain network strength is referred as the
minimum number of edges linking the nodes.
34. ◘ The tinny WMHs lesions disrupt the traversing axons
with a resultant die back of their neuronal cell bodies
and secondary disruption of brain network integrity
progressing to disconnection syndrome. (20)
◘ The brain undergoes several neuro-modulatory processes
resulting in paradoxical functional hyper-connectivity
by reorganizing the resting-state and default mode
networks to reduce the cost of wiring.(39)
◘ These brain organizational changes result in delayed
clinical implications of WMHs, but unfortunately on
the expense of network reserve. (4)
35. Normally activated areas
Additionally activated areas in
WMHs
◘ This study showed the compensatory mechanisms of brain networks in response to cognitive as well as motor tasks in patients with high WMHs
burdenbyrecruitmentofsecondarynetworkstoperformequivalenttasks(reorganizationof defaultnetworks).
36.
37. ◘ WMHs are among the strongest radiological predictors of
cognitive functions and both the severity and
distribution may alter the risk and progression of
cognitive impairment.
◘ Extensive WMHs greater than expected for age are
associated with double risk of VCI. (33)
◘ Increasing parietal lobe WMHs volume is associated with
AD and is a biomarker of its rapid progression. (39)
MixedVascularand AlzheimerDementia
38. ◘ Extensive WMHs is associated with
triple risk of stroke as well as poor
functional outcome after stroke.
◘ Stroke is a major risk of dementia and
cognitive decline predict upcoming
stroke.
◘ Like an ink drop falling into a glass of
water, an occult or a manifest stroke
may start neuropathological changes
disrupting white matter tracts and end
in post-stroke cognitive impairment.
39.
40. ◘ Onesizetreatment will not fit for all:-
(1) Management of patients at risk of WMHs
development may differ from those with already
established lesions where the aim is to slowdown the
disease progression.
(2) Preventive measures for development of acute stroke
are quite different from protocols done to protect
against gradually progressing VCI.
(3) Treatment protocols for the chronic WMHs must be
designed for long-term use.
41. ◘ Many observational studies concluded that, prevention and/or slowing down of WMHs progression should be started very early in the
presymptomaticphasebeforeirreversibleneuronaldamagetakesplace.
42.
43. ◘ Vascular risk reduction strategies may offer some
value for prevention and treatment of WMHs.
◘ However, some studies assumed that, WMHs is
highly heritable (e.g. PLEKHG1 gene that encodes
a Rho guanyl-nucleotide exchange factor) while
risk factors control has very limited values in
striking disease progression.
44. ◘ Hypertension is the most important independent risk
factor for WMHs development.
◘ However, the relation of blood pressure control as well
as the targeted blood pressure level is obscured.
◘ In the PROGRESS MRI sub-study as well as ACCORD
MIND study, higher systolic blood pressure was
associated with WMHs progression while intensive
blood pressure control reduced this progression in 3-
years MRI follow-up.
45. ◘ The SPS3 study showed non-significant decrease in the
risk of new occult LBIs or WMHs progression by
lowering systolic blood pressure to 130 mmHg,
possibly due to inclusion of patients after symptomatic
stroke. (19)
◘ Excess blood pressure reduction (systolic <125 mmHg) is
not indicated in severe WMHs due to impaired
autoregulation and increased risk of falls by the
associated subtler gait and balance disturbances. (21)
47. ◘ For statin treatment-based trials, conflicting results were
attained.
◘ Some RCTs showed evidences of valuable roles of statins
in reduction of WMHs disease load progression and
consequent stroke and cognitive decline risks
explained by the statin induced antiplatelet, anti-
inflammatory and pro-endothelial activity (increase
NO production). (23)
◘ On the other hand, some studies showed non-beneficial
effects of statins with a superadded increased risk of
ICH in patients with extensive WMHs .
48.
49. (1)NitricOxideDonors:-
- Sodium nitroprusside, isosorbide mononitrate and
glyceryl trinitrate.
(2)Phosphodiesterase(PDE)3 and5: -
(a) Non-selective as pentoxifylline.
(b) Selective PDE–5 inhibitors (e.g. dipyridamole, tadalafil
or Cialis).
(c) Selective PDE–3 inhibitors (e.g. cilostazol or triflusal).
(3)Endothelin-1antagonists:-
- Clazosentan and TAK-044.
(4)Pioglitazone:-
- A peroxisome proliferator-activated receptor gamma
(PPAR-γ) agonist.
Tract-definedregionalWMHs(30)
50. ◘ Such drugs are theoretically beneficial, but there is a
paucity of studies regarding their values:
(1) Matrix metalloproteinases–9 inhibitors (minocycline).
(2) Antioxidants.
(3) Topiramate.
(4) Vascular endothelial growth factors antibodies.
(5) Cyclic AMP modulators (cilostazol, pentoxifylline).
(6) Fasudil is a selective rho-kinase inhibitor used in
management of vasospasm following SAH, however
its use in WMHs is still unevidenced.
51. (1) NSAIDs inhibit cyclooxygenase-2 with consecutive
decrease in prostaglandins formation, but the
serious GIT bleeding makes the drawbacks
outweigh the benefits.
(2) Fingolimod and natalizumab have been tried with
limited success.
(3) Allopurinol increases NO availability and has anti-
inflammatory effects, however, its value in
reduction of WMHs progression is doubtful.
52. ◘ Obesity is associated with more microstructural changes
within the WMHs (lower fractional anisotropy DTI).
(23, 25)
◘ Lifestyle modifications including weight control,
smoking cessation, salt reduction, increased dietary
nitrates, dietary flavanones and regular exercises have
their potential to reduce the risk of WMHs
cerebrovascular and cognitive complications. (36)
53. ◘ Trials used multiple classes of vitamins failed to
prevent stroke risk in WMHs.
◘ The VITATOPS trial (Vitamins to Prevent Stroke),
MRI sub-study suggested that Mediterranean diet
with daily vitamin B6, B12 and folate
supplementation for 2 years might be associated
with less WMHs progression in non-stroke
patients.
◘ On the other hand, stroke patients showed non-
significant effect of daily vitamin B
supplementation on WMHs progression.
54.
55. ◘ Warfarin use is associated with increased ICH
risk in patients with extensive WMHs.
◘ A single antiplatelet agent may be beneficial
for secondary stroke prevention with lower
risk of hemorrhage.
◘ The SPS-3 (Small Subcortical Strokes) trial
revealed that, long-term dual
aspirin/clopidogrel therapy double the risk
of major ICH and mortality in WMHs
patients which out-weight the benefits of
secondary stroke prevention. (27)
56. ◘ The benefits of cholinesterase inhibitors (tacrine,
rivastigmine, galantamine and donepezil) as well as
NMDA receptor antagonist (memantine) in
management of VCI associating WMHs were very
minimal.
◘ The NICE guidelines as well as the FDA do not
recommend the use of antidementia drugs for VCI
except in mixed dementia with predominant
Alzheimer’s component.
57.
58. ◘ AccidentlydiscoveredWMHs are neithersilent norinnocent.
◘ Avoid the use of dual antiplatelets or antidementia drugs in WMHs without
reasonableindication.
◘ Lifestylemodificationis effective, has no sideeffectsandfreeof charge.
◘ The introduction of non-invasive, sensitive, inexpensive biomarkers is crucial, but
the costs/benefits of screening high risk healthy individuals need to be
estimated.
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[2] Wardlaw et al., J Am Heart Assoc. 2015; doi: 10.1161/JAHA.114.001140
[3] Wardlaw et al., Alzheimers Dement. 2017; doi: 10.1016/j.jalz.2016.09.006
[4] Wardlaw et al., Lancet Neurol. 2019; doi: 10.1016/S1474-4422(19)30079-1
[5] Frey et al., Front. Neurol., 2019. doi: 10.3389/fneur.2019.00238
[6] Puy et al. Stroke; 2018. doi: 10.1161/STROKEAHA.118.021981
[7] Rensma et al., Neurosci Biobehav Rev. 2018; doi:
10.1016/j.neubiorev.2018.04.003
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[22] ACCORD MIND Lancet Neurol. 2011; doi: 10.1016/S1474-4422(11)70188-0
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[26] Bailey. Am J Lifestyle Med. 2018. doi: 10.1177/1559827616633683
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[28] Bath et al., Int J Stroke. 2015;. doi: 10.1111/ijs.12466
[29] Balconi et al., Brain and Cognition. 2018. doi: 10.1016/j.bandc.2018.02.009
[30] Rizvi etal., NeuroImage: Clinical. 2020; doi: 10.1016/j.nicl.2019.102143
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