Articles from Neurology

Link to journal online
Grommes, Christian ; Oghlakian, Roger ; Blackham, Kristina A. ; De Georgia, Michael A.
Corpus callosum dysgenesis limits MRI changes to one hemisphere in status epilepticus
Source
Neurology. 72(10):942, March 10, 2009.

Bonhomme, G R. MD *; Waldman, A T. MD *; Balcer, L J. MD, MSCE; Daniels, A B. et al
Pediatric optic neuritis: Brain MRI abnormalities and risk of multiple sclerosis
Neurology. 72(10):881-885, March 10, 2009.
Abstract
Background: Optic neuritis is often the initial presentation of multiple sclerosis (MS). As established by the Optic Neuritis Treatment Trial, an abnormal baseline brain MRI is a strong predictor of MS after isolated optic neuritis in adults. However, the rate of conversion to MS after optic neuritis in children based upon brain MRI findings is unknown.Methods: We reviewed the medical records of children (<18 p =" 0.04," chop =" Children's" flair =" fluid-attenuated" ms =" multiple" nmo =" neuromyelitis" ontt =" Optic">

Lee, K Y. ; Latour, L L. ; Luby, M ; Hsia, A W. ; Merino, J G. , MPhil; Warach, S
Distal hyperintense vessels on FLAIR: An MRI marker for collateral circulation in acute stroke?
Neurology.
Status
Publish Ahead of Print, POST AUTHOR CORRECTIONS, 11 February 2009
Abstract
Background: Hyperintense vessels (HV) on fluid-attenuated inversion recovery imaging are frequently observed in acute ischemic stroke patients. However, the exact mechanism and clinical implications of this sign have not yet been clearly defined. The features of HV and its relevance to other imaging factors are presented here.Methods: Prominence and location of HV were documented in 52 consecutive patients with middle cerebral artery (MCA) territory infarction, before treatment with IV recombinant tissue plasminogen activator. Pretreatment ischemic lesion volume, perfusion lesion volume, and vessel occlusion were determined in addition to recanalization status and ischemic lesion volume on follow-up imaging. NIH Stroke Scale (NIHSS) was used as a measure of clinical severity.Results: HV distal to arterial occlusion was observed in 73% of patients; more frequent in proximal than distal MCA occlusion patients. Among the 38 patients with proximal MCA occlusion, initial perfusion lesion volume was comparable among patients with different grade distal HV. However, patients with more prominent distal HV had smaller initial, 24-hour, and subacute ischemic lesion volumes and lower initial NIHSS scores.Conclusions: The presence of distal hyperintense vessels before thrombolytic treatment is associated with large diffusion-perfusion mismatch and smaller subacute ischemic lesion volumes in patients with proximal middle cerebral artery occlusion.GLOSSARY: DWI = diffusion-weighted imaging; FLAIR = fluid-attenuated inversion recovery; GRE = gradient recalled echo; HV = hyperintense vessels; MCA = middle cerebral artery; MRA = magnetic resonance angiography; MTT = mean transit time; NIHSS = NIH Stroke Scale; PWI = perfusion-weighted imaging; rt-PA = recombinant tissue plasminogen activator; TE = echo time; TI = inversion time; TIMI = thrombolysis in myocardial infarction; TR = repetition time.

Cadavid, D ; Wolansky, L J. ; Skurnick, J ; Lincoln, J et al
Efficacy of treatment of MS with IFN[beta]-1b or glatiramer acetate by monthly brain MRI in the BECOME study
Neurology.
Status
Publish Ahead of Print, POST AUTHOR CORRECTIONS, 11 March 2009
Abstract
Background: There are no published MRI studies comparing interferon beta 1b (IFN[beta]-1b) and glatiramer acetate (GA) for treatment of relapsing multiple sclerosis (MS).Objective: To compare the efficacy of IFN[beta]-1b and GA for suppression of MS disease activity as evidenced on frequent brain MRI.Methods: A total of 75 patients with relapsing-remitting MS or clinically isolated syndromes were randomized to standard doses of IFN[beta]-1b or GA and followed by monthly brain MRI for up to 2 years with a protocol optimized to detect enhancement. The primary outcome was the number of combined active lesions (CAL) per patient per scan during the first year, which included all enhancing lesions and nonenhancing new T2/fluid-attenuated inversion recovery (FLAIR) lesions. Secondary outcomes were the number of new lesions and clinical exacerbations over 2 years.Results: Baseline characteristics were similar between the groups. The primary outcome showed similar median (75th percentile) CAL per patient per scan for months 1-12, 0.63 (2.76) for IFN[beta]-1b, and 0.58 (2.45) for GA (p = 0.58). There were no differences in new lesion or clinical relapses for 2 years. Only 4.4% of CAL on monthly MRI scans were nonenhancing new T2/FLAIR lesions.Conclusion: Patients with relapsing multiple sclerosis randomized to interferon beta 1b or glatiramer acetate showed similar MRI and clinical activity.GLOSSARY: ARR = annualized relapse rates; BECOME = Betaseron vs Copaxone in Multiple Sclerosis with Triple-Dose Gadolinium and 3-Tesla MRI Endpoints; CAL = combined active lesions; CIS = clinically isolated syndromes; EDSS = Expanded Disability Status Scale; GA = glatiramer acetate; IFN[beta]-1b = interferon beta 1b; FLAIR = fluid-attenuated inversion recovery; MS = multiple sclerosis; MSFC = Multiple Sclerosis Functional Composite; NEL = newly enhancing lesions; NL = new lesions; RRMS = relapsing-remitting MS; SNRS = Scripps Neurological Rating Scale.(C)2009AAN Enterprises, Inc.


Mlynash, M MD, MS; Olivot, J H. MD, PhD; Tong, D C. MD, FAHA; Lansberg, M G. et al
Yield of combined perfusion and diffusion MR imaging in hemispheric TIA
Neurology.
Status
Publish Ahead of Print, POST AUTHOR CORRECTIONS, 17 December 2008
Abstract
Objective: Transient ischemic attacks (TIA) predict future stroke. However, there are no sensitive and specific diagnostic criteria for TIA and interobserver agreement regarding the diagnosis is poor. Diffusion-weighted MRI (DWI) demonstrates acute ischemic lesions in approximately 30% of TIA patients; the yield of perfusion-weighted MRI (PWI) is unclear.Methods: We prospectively performed both DWI and PWI within 48 hours of symptom onset in consecutive patients admitted with suspected hemispheric TIAs of <24 hours symptom duration. Two independent raters, blinded to clinical features, assessed the presence and location of acute DWI and PWI lesions. Lesions were correlated with suspected clinical localization and baseline characteristics. Clinical features predictive of a PWI lesion were assessed.Results: Forty-three patients met the inclusion criteria. Thirty-three percent had a PWI lesion and 35% had a DWI lesion. Seven patients (16%) had both PWI and DWI lesions and 7 (16%) had only PWI lesions. The combined yield for identification of either a PWI or a DWI was 51%. DWI lesions occurred in the clinically suspected hemisphere in 93% of patients; PWI lesions in 86%. PWI lesions occurred more frequently when the MRI was performed within 12 hours of symptom resolution, in patients with symptoms of speech impairment, and among individuals younger than 60 years.Conclusions: The combination of early diffusion-weighted MRI and perfusion-weighted MRI can document the presence of a cerebral ischemic lesion in approximately half of all patients who present with a suspected hemispheric transient ischemic attack (TIA). MRI has the potential to improve the accuracy of TIA diagnosis.GLOSSARY: ACA = anterior cerebral artery; CI = confidence interval; DWI = diffusion-weighted MRI; ICA = internal carotid artery; MCA = middle cerebral artery; MRA = magnetic resonance angiography; MTT = mean transit time; OR = odds ratios; PCA = posterior cerebral artery; PWI = perfusion-weighted MRI; RR = risk ratios; TIA = transient ischemic attacks; TOAST = Trial of Org 10172 in Acute Stroke Treatment.(C)2009AAN Enterprises, Inc.