Purpose: To determine whether the hypothesis that the phenomenon of persistent cytotoxic edema in the subacute stage of ischemic stroke is in fact associated with the glial population. This is done by assessing the evolution of both the apparent diffusion coefficient (ADC) and the glial-specific marker myo-inositol (Ins) in a group of patients, and by comparing the results with the total cellular density by means of the creatine (Cre) level. Material and Methods:Twenty-two patients with stroke in the territory of the middle cerebral artery were each examined once only at a time ranging from eight hours to six days following the onset of symptoms. Lesion-to-contralateral values of ADC were obtained based on diffusion-weighted echoplanar imaging. Short TE single-voxel proton magnetic resonance ( 1 H MR) spectroscopy was used for quantification of cerebral metabolites in infarcted regions. Their levels were also compared with those in homotopic contralateral regions. Results:In the stroke lesion, there was a significant correlation between ADC and the Ins level, albeit less pronounced than that for Cre. During different pathophysiological stages between 12 hours and three days, the Ins-toCre ratio increased by a factor of two and returned to apparently normal thereafter. Conclusion:Our study provides the first demonstration of a relationship between persistent cytotoxic edema and the glial population in the context of cell swelling due to osmotic imbalance in stroke patients.
Paraclinical evidence, consisting of evoked potentials study, cerebrospinal fluid analysis or imaging techniques, has been accepted in the diagnosis of multiple sclerosis (MS). 1 Magnetic resonance imaging (MRI), of the brain in particular, is known to be very helpful, with a sensitivity reaching 95%. 2 Various brain MRI lesions were considered specific to MS in patients younger than 50 year-old; among these were periventricular lesions, 2-4 gadolinium enhancement, 4-8 large lesions, 3 ovoid and callosal or sub-callosal lesions, 9-11 and the total number of lesions or lesion ABSTRACT: Magnetic resonance imaging (MRI) of the brain is the most important paraclinical diagnostic test in multiple sclerosis (MS). The appearance of MRI in Asians with MS is not well defined. We retrospectively surveyed the first brain and spinal cord MRI in patients diagnosed to have MS, according to Poser's criteria in seven regions throughout Asia to define the MRI changes among Asians with MS. There were 101 patients with first brain, and 86 with first spinal cord MRI, 66 of whom had both. The brain MRI showed a mean of 17 lesions per patient in T2 weighted images, mostly asymptomatic. Almost all the lesions were in the white matter, particularly in the juxtacortical, deep and periventricular white matter. A third of the lesions were greater than 5 mm, 14% enhanced with gadolinium. There were more supratentorial than infratentorial lesions at a ratio of 7.5: 1. Ninety five percent of the spinal cord lesions were in cervical and thoracic regions, 34% enhanced with gadolinium. The lesions extended over a mean of 3.6 ± 3.3 vertebral bodies in length. Fifty (50%) of the brain and 54 (63%) of the spinal MRI patients had the optic-spinal form of MS. The MRI of the optic-spinal and classical groups of patients were similar in appearance and distribution, except that the optic-spinal MS patients have fewer brain but longer and more severe spinal cord lesions. In conclusion, the brain and spinal cord MRI of Asian patients with MS was similar to that of the West, although, in this study, Asian MS patients had larger spinal cord lesions.RÉSUMÉ: L'imagerie par résonance magnétique est similaire chez des patients atteints de sclérose en plaques, qu'ils soient d'Asie ou de l'Ouest. L'imagerie par résonance magnétique (IRM) du cerveau est l'épreuve diagnostique paraclinique la plus importante dans la sclérose en plaques (SEP). Les caractéristiques de l'IRM chez les Asiatiques atteints de SEP sont mal connues. Nous avons analysé rétrospectivement l'IRM initiale du cerveau et de la moelle épinière chez des patients dont le diagnostic de SEP avait été fait selon les critères de Poser dans sept régions d'Asie, afin de préciser les changements observés à l'IRM chez des Asiatiques atteints de SEP. L'imagerie du cerveau était disponible chez 101 patients, celle de la moelle épinière chez 86 patients et celle du cerveau et de la moelle épinière chez 66 patients. À l'IRM du cerveau, le nombre moyen de lésions par patient était de 17 sur les images pondérées...
Syphilis is a sexually transmitted disease caused by spirochaete Treponema pallidum. The incidence of syphilis is rising across the globe. It has been described in the literature as a great imitator due to the vast range of clinical manifestations that can occur in the disease. Renal manifestations are rare but a feature of secondary syphilis. It can cause glomerulopathies, tubular pathology and vasculitic lesions in the kidney. Membranous nephropathy is the most commonly reported glomerular lesion associated with syphilis. With two recent cases of secondary membranous nephropathy due to syphilis, it is timely to review the current state of knowledge, and discuss the different renal manifestation of syphilis, its pathology and treatment options.
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