摘要:

The clinical presentation, risk factors, laboratory data, and neuroimaging and neuropathological findings in 26 patients with autopsy proved central nervous system (CNS) aspergillosis are reviewed. Eleven patients had hematological malignancies (8 underwent bone marrow transplantation), 8 patients underwent liver transplantation, and 3 patients had acquired immunodeficiency syndrome. Four had illnesses resulting in immunosuppression (systemic lupus erythematosus, infected aortic graft, neuroblastoma, and fulminant hepatic failure). The most common presenting clinical symptoms of CNS aspergillosis were fever and a strokelike syndrome. Risk factors for developing CNS aspergillosis included neutropenia, immunosuppressive therapy, low CD4 counts, and retransplantation. Spinal fluid findings were nondiagnostic. Computed tomograms and magnetic resonance scans of the head showed low‐density lesions or hemorrhagic infarctions. Most aspergillosis cases occurred in the setting of widely disseminated disease commonly arising from the lung. Pathologically, multiple areas of necrosis throughout the brain were seen. Aspergillus invasion of blood vessel walls was seen microscopically. Amphotericin B with or without flucytosine was not effective treatment.

ISSN:1051-2284    

DOI:10.1111/jon199443123

出版商:Wiley    

年代:2016

数据来源: WILEY

ISSN:1051-2284    

DOI:10.1111/jon199443129

出版商:Wiley    

年代:2016

数据来源: WILEY

摘要:

To show a relationship between age and cerebral blood flow as well as between age and cerebral vasocapacitance to induced hypercapnia or cerebral reserve percentage, positron emission tomography (PET) with fluorine‐18‐fluoromethane was used to study 36 normal subjects and 36 patients, all free of stroke, who presented with transient ischemic attacks in a unilateral carotid distribution. Symptomatic‐side data have been published elsewhere. All asymptomatic carotid arteries were either normal or had nonstenotic plaque, and subjects were free of intracranial stenoses. Cerebral blood flow and cerebral reserve percentage were calculated for both middle cerebral artery flow territories. Serum hematocrit, expired carbon dioxide tension, and mean arterial blood pressure did not distinguish the two groups of patients or show an age effect. For the 72 normal nonstenotic sides in the volunteers, linear regression showed that while increasing age was significantly related to decreasing cerebral blood flow in the middle cerebral artery, there was no particular relationship between age and decreasing cerebral reserve percentage. In patients, while no overwhelming linear relationships were found between age and decreases in either cerebral blood flow or cerebral reserve percentage, the latter values approached significance as declining cerebral reserve percentage did relate to increasing age. Over a 60‐year range in normal subjects, cerebral blood flow declined 37% with age; there was a 21% age‐related decrease when normal subjects 50 years and younger were compared to those 50 years and older. Cerebral blood flow is impaired by the aging process in normal subjects and both cerebral blood flow and cerebral reserve percentage of the middle cerebral artery are lowered, presumably by some aspect of the atherosclerotic or ischemic process in patients.

ISSN:1051-2284    

DOI:10.1111/jon199443130

出版商:Wiley    

年代:2016

数据来源: WILEY

摘要:

To accelerate publication time of articles inJournal of Neuroimaging, the American Society of Neuroimaging has decided to establish a new policy that authors will no longer be able to review copyedited manuscript. This, as you know, is standard practice among many of the world's leading journals.

ISSN:1051-2284    

DOI:10.1111/jon199443136

出版商:Wiley    

年代:2016

数据来源: WILEY

摘要:

Transcranial Doppler ultrasonography can monitor changes in intracranial blood flow velocity over time in a variety of experimental and clinical settings with excellent temporal resolution. Alterations in arterial carbon dioxide pressure exert a profound influence on blood flow velocity. Such changes exhibit important individual fluctuation depending on respiratory status. This limits the ability of transcranial Doppler to accurately study subtle changes in blood flow velocity, independent of the respiratory state of the subject. Suggested here is a method to control for the respiration artifact on blood flow velocity. The middle cerebral artery of 7 healthy male volunteers was studied with transcranial Doppler under resting conditions, monitoring end‐tidal carbon dioxide concentration and blood flow velocity. Hyperventilation was performed both voluntarily and with pharmacological induction by human corticotropin‐releasing hormone. These studies were carried out both with and without the use of counterregulation of the end‐tidal carbon dioxide concentration via a respiration unit, with an adjustable carbon dioxide‐oxygen gas supply preventing significant changes in end‐tidal carbon dioxide. The blood flow velocity in the middle cerebral artery during maximal voluntary hyperventilation decreased from baseline values of 100% to 44.4 ± 4.3% (a 55.6% decrease), and with human corticotropin‐ releasing hormone‐induced involuntary hyperventilation, to 65.1 ± 5.3% (a 34.9% decrease). With the control method, blood flow velocities during voluntary and pharmacological hyperventilation were 100 ± 1.6% and 100 ± 2.8%, respectively. This method allows for control of respiration‐induced artifacts during transcranial Doppler monitoring, and can be used to assess the effect of direct or indirect blood flow velocity stimuli independent of respiratory status.

ISSN:1051-2284    

DOI:10.1111/jon199443137

出版商:Wiley    

年代:2016

数据来源: WILEY

摘要:

Nine patients with multiple sclerosis underwent brain magnetic resonance imaging (MRI) to evaluate the contrast enhancement of individual lesions after a single dose and a triple dose of gadolinium. A single dose (0.1 mmol/kg) of gadoteridol was administered and after a delay, axial T1‐weighted images were obtained. After an additional 0.2‐mmol/kg dose, the same T1‐weighted sequence was repeated. An unblinded reader simultaneously viewed the images from both doses, and utilizing a computer console to rule out flow artifacts, created a gold standard of “definite” enhancing lesions. Using this system, he determined that there was a total of 12 definite enhancing lesions among the patients. This reader also evaluated lesion conspicuity. The contrast‐noise ratio was calculated for each lesion. A second reader, blinded to the dose used, then evaluated the number of enhancing lesions at both doses. The unblinded reader noted increased lesion conspicuity after the triple dose. Contrast‐noise ratios were significantly (p<0.001) higher after the triple dose (mean, 9.19) than after the single dose (mean, 2.97). The blinded reader detected 11 of the 12 definite lesions on MRis after the triple dose (sensitivity, 92 %) but saw only 6 on MRis after the single dose (sensitivity, 50%). The difference was significant (p<0.001 ). Subjective analysis of the films revealed an increase in “ghosting artifacts” at the high dose. Administration of tripledose gadolinium provides increased lesion conspicuity and an improved lesion detection rate when compared to single‐dose gadolinium in patients with multiple sclerosis.

ISSN:1051-2284    

DOI:10.1111/jon199443141

出版商:Wiley    

年代:2016

数据来源: WILEY

摘要:

Magnetic resonance imaging (MRI) has become an important diagnostic tool in the evaluation of neurodegenerative diseases. Although MRI currently does not yield sufficient predictive power to provide a diagnosis in most individual cases, important features have been identified in population studies that help support or exclude a clinical diagnosis under consideration. In parkinsonian patients, putamenal signal hypointensity is commonly observed in patients with atypical parkinsonism. In demented patients, hippocampal atrophy and prolonged T2 relaxation may help identify individuals with Alzheimer's disease. Caudate and putamenal atrophy are seen in Huntington's disease and may serve as markers of disease progression.

ISSN:1051-2284    

DOI:10.1111/jon199443146

出版商:Wiley    

年代:2016

数据来源: WILEY

摘要:

Transcranial Doppler mapping, dual monitoring, color imaging, emboli detection, and insonation after administration of contrast media are recent technological advances that promise to bring new capabilities to transcranial Doppler ultrasonography, and are likely to change its applications in the near future. This article presents a critical review of these developments.

ISSN:1051-2284    

DOI:10.1111/jon199443159

出版商:Wiley    

年代:2016

数据来源: WILEY

摘要:

A 70‐year‐old man presented with a 12‐year history of intractable hiccups. Magnetic resonance imaging and cerebral angiography revealed dolichoectasia of the right vertebral artery with compression of the brainstem at the pontomedullary level.

ISSN:1051-2284    

DOI:10.1111/jon199443164

出版商:Wiley    

年代:2016

数据来源: WILEY

摘要:

The natural history of arachnoid cysts is not uniform; some cysts enlarge and some remain unchanged. A less recognized course is spontaneous resolution. A patient with an arachnoid cyst that resolved spontaneously is described, previously reported cases of 6 patients are reviewed, and possible mechanisms for resolution of the cysts are discussed.

ISSN:1051-2284    

DOI:10.1111/jon199443165

出版商:Wiley    

年代:2016

数据来源: WILEY