Our retrospective study confirms that morbidity and mortality rates in treatment with FDD of unruptured wide-neck or untreatable cerebral aneurysms do not differ from those reported in the largest series.
Summary: Purpose: To assess the role of 'H-magnetic resonance spectroscopy (MRS) in detecting biochemical abnormalities in neuronal migration disorders (NMDs).Methods: We performed 'H-MRS studies on 17 brain NMD areas [five polymicrogyria, eight subcortical heterotopia, and four cortical dysplasia on magnetic resonance imaging (MRI)]. The study group consisted of I5 patients, all but one affected by partial epileptic seizures. Spectra were acquired from volumes of interest localized on NMDs and contralateral sides and compared with those obtained on gray and white matter of 18 neurologic controls.Results: NMD lesions were characterized by lower Nacetylaspartate to creatine (NAAICr) and choline to Cr (Chot Cr) ratios than those of the white (p = 0.002 and p = 0.004) and gray matter (p = 0.03 and p = 0.06) of neurologic controls. In addition, the nonnal-appearing contralateral sides to the NMD lesions showed a significant decrease of Cho/Cr ratio when compared with those of white (p = 0.003) and gray matter (p = 0.05) of neurologic controls. No relation was found between NAAlCr decrease, EEG abnormalities, and NMD sides, or between NANCr ratios, duration of epilepsy, and frequency of seizures. Lactate signal was detected in the spectra of four patients who had an epileptic seizure a short time before MR examination.Conclusions: NAA/Cr decrease may be related more to structural and functional alteration of the NMD sides than to epileptic activity in these lesions. Low Cho/Cr may be related to a more extensive diffuse hypomyelination than suggested by the MRI findings. An activation of anerobic glycolysis during and after seizures could account for the presence of lactate. These data confirm that 'H-MRS is an advanced technique that may provide useful biochemical information in vivo on neurobiologic processes underlying NMDs. Key Words: Neuronal migration disorders-Epilepsy-Proton magnetic resonance spectroscopy-Magnetic resonance imaging.Neuronal migration disorders (NMDs) are a broad group of brain illnesses characterized by anomalies of site, thickness, shape, and organization of cerebral cortex due to a complete or partial failure of the neuroblast migration process, which may occur between the gestational weeks 8 and 15 (1,2). The etiology of NMD is extremely varied and may include genetic and chromosomal factors or maternal and environmental causes (for example, toxic, infectious, and hypoxichschemic) (3).Several clinical studies reported that frequently NMDs are associated with severe partial epilepsy, suggesting a combination of morphologic and functional abnormali-
Bipolar disorder (BD) could represent a prodromal state of frontotemporal dementia (FTD). Two patients affected by lifelong BD with a progressive decline of cognitive functions, behavioral, and neurological signs, reached the early diagnosis of FTD before the age of 60. They were diagnosed as affected by primary progressive aphasia and FTD with parkinsonism, respectively. A diagnosis of FTD should therefore be taken into account, in case of unexpected cognitive and behavioral decline in patients with a long history of BD. Follow-up studies with genetic, neuropsychological, and neuroimaging markers of these BD/FTD patients could further explore some of the underlying association, opening new viable therapeutic options.
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