Combining elaborate neurophysiological assessment, tractography-based neuronavigation, and updated IOUS images provided accurate localization of the CSTs and enabled the safe resection of tumors approximating these tracts. This is the first attempt to evaluate the distance from the CSTs using the threshold of subcortical monopolar stimulation with real-time IOUS for the correction of brain shift. The linear correlation between the distance to the CSTs and the threshold of subcortical stimulation producing a motor response provides an intraoperative technique to better preserve motor function.
Ž. Background: Acute pulmonary oedema APOE is a major health problem, leading to poor hospital and long-term outcomes. There is a relative paucity of studies describing prognosis of consecutive unsolicited patients diagnosed with APOE and Ž hospitalized in internal medicine departments. Aims: To describe the clinical profile and outcome in hospital and 1-year . prognosis of successive unselected patients with APOE, in a prospective observational study. Methods and results: The study Ž . population included 150 consecutive unsolicited patients 90 men, 60 women; median age 75 years with APOE all hospitalized Ž . in an internal medicine department, in a 900-bed care centre. Ischaemic heart disease IHD , hypertension and diabetes were present in 85%, 70% and 52% of patients, respectively. The most common precipitating factors for APOE included high blood Ž . Ž . Ž . Ž . pressure 29% , rapid atrial fibrillation 29% , unstable angina pectoris 25% , infection 18% and acute myocardial infarction Ž . Ž . MI; 15% . Eighteen patients 12% died in hospital, with 82% of these deaths attributed to cardiac pump failure. Predictors Ž . Ž . for an increased in-hospital mortality included: diabetes P -0.05 , orthopnoea P -0.05 , echocardiographic finding of Ž . Ž . depressed global left ventricular systolic function P-0.001 , acute MI during hospital stay P-0.001 , hypotensionrshock Ž . Ž . P -0.05 , and the need for mechanical ventilation P-0.001 . After a median hospital stay of 10 days, 132 patients were discharged home. The 1-year mortality was 40%. Only the presence of pleural effusion was found as a predictor for 1-year mortality. Conclusion: Most patients with APOE in this study are elderly, and have IHD, hypertension, diabetes and a previous Ž . history of APOE. The overall mortality is high in-hospital, 12%: 1-year, 40% . Left ventricular dysfunction was associated with high in-hospital mortality, but not with long-term prognosis. ᮊ
Blood oxygenation level dependence (BOLD) imaging under either hypercapnia or hyperoxia has been used to study neuronal activation and for assessment of various brain pathologies. We evaluated the benefit of a combined protocol of BOLD imaging during both hyperoxic and hypercapnic challenges (termed hemodynamic response imaging (HRI)). Nineteen healthy controls and seven patients with primary brain tumors were included: six with glioblastoma (two newly diagnosed and four with recurrent tumors) and one with atypical-meningioma. Maps of percent signal intensity changes (ΔS) during hyperoxia (carbogen; 95%O2+5%CO2) and hypercapnia (95%air+5%CO2) challenges and vascular reactivity mismatch maps (VRM; voxels that responded to carbogen with reduced/absent response to CO2) were calculated. VRM values were measured in white matter (WM) and gray matter (GM) areas of healthy subjects and used as threshold values in patients. Significantly higher response to carbogen was detected in healthy subjects, compared to hypercapnia, with a GM/WM ratio of 3.8 during both challenges. In patients with newly diagnosed/treatment-naive tumors (n = 3), increased response to carbogen was detected with substantially increased VRM response (compared to threshold values) within and around the tumors. In patients with recurrent tumors, reduced/absent response during both challenges was demonstrated. An additional finding in 2 of 4 patients with recurrent glioblastoma was a negative response during carbogen, distant from tumor location, which may indicate steal effect. In conclusion, the HRI method enables the assessment of blood vessel functionality and reactivity. Reference values from healthy subjects are presented and preliminary results demonstrate the potential of this method to complement perfusion imaging for the detection and follow up of angiogenesis in patients with brain tumors.
Amyloidoma is a term referring to a tumor-like deposition of extracellular insoluble fibrillar protein. Tumor-like amyloid formation in the brain had been described in isolated cases. However no advanced radiological studies to characterize these lesions have been reported. In the report, we have describe a 59-year-old woman, presented several months prior to diagnosis with memory decline, dizziness, walking instability, and speech difficulties. MRI revealed a left basal ganglia lesion with an intraventricular component. The patient underwent a stereotactic biopsy, which confirmed the diagnosis of amyloidoma, an extensive radiographic characterization of amyloidoma using advanced MR techniques was done, including magnetic resonance spectroscopy, dynamic susceptibility contrast, susceptibility weighted image (SWI), and magnetization transfer (MTR). All advanced MR techniques were able to characterize the amyloidoma as a non-neoplastic process. This is an example where such methods can be used for differential diagnosis of atypical brain lesions.
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