| In Focus |
spotlight on the january 31 issue.
- Gross, Robert, MD, PhD, Editor-in-Chief, Neurology. Pages: 295
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| Editorials |
ms cortical lesions on double inversion recovery mri: few but true.
- Ciccarelli, Olga, Chen, Jacqueline. Pages: 296-297
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understanding risk in asymptomatic carotid stenosis: lessons from patients' preferences.
- Saposnik, Gustavo, MD, MSc, FAHA, FRCPC, Topakian, Raffi. Pages: 298-299
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is the development of late-life cognitive impairment more dynamic than sexy?.
- Rockwood, Kenneth. Pages: 300-301
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| Articles |
postmortem verification of ms cortical lesion detection with 3d dir.
- Seewann, A., Kooi, E.-J., Roosendaal, S.D., Pouwels, P.J.W., Wattjes, M.P., van der Valk, P., Barkhof, F., Polman, C.H., Geurts, J.J.G.. Pages: 302-308
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Objective: To assess the sensitivity and specificity of 3D double inversion recovery (DIR) MRI for detecting multiple sclerosis (MS) cortical lesions (CLs) using a direct postmortem MRI to histopathology comparison.Methods: Single-slab 3D DIR and 3D fluid-attenuated inversion recovery (FLAIR) images of 56 matched fresh brain samples from 14 patients with chronic MS were acquired at 1.5 T. The images of both sequences were prospectively scored for CLs in consensus by 3 experienced raters who were blinded to histopathology and clinical data. Next, CLs were identified histopathologically and were scored again on 3D DIR and 3D FLAIR (retrospective scoring). CLs were classified as intracortical or mixed gray matter (GM)-white matter lesions. Deep GM lesions were also scored. False-positive scores were noted and, from this, specificity was calculated.Results: We found a sensitivity for 3D DIR to detect MS CLs of 18%, which is 1.6-fold higher than 3D FLAIR (improves to 37% with retrospective scoring; 2.0-fold higher than 3D FLAIR). We detected mixed GM-white matter lesions with a sensitivity of 83% using 3D DIR (65% sensitivity for 3D FLAIR), which improved to 96% upon retrospective scoring (91% for 3D FLAIR). For purely intracortical lesions, 3D DIR detected more than 2-fold more than 3D FLAIR (improved to >3-fold upon retrospective scoring). The specificity of 3D DIR to MS CLs was found to be 90%.Conclusions: In this postmortem verification study, we have shown that 3D DIR is highly pathologically specific, and more sensitive to CLs than 3D FLAIR in MS.(C)2012 American Academy of Neurology
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association of mri metrics and cognitive impairment in radiologically isolated syndromes.
- Amato, M.P., Hakiki, B., Goretti, B., Rossi, F., Stromillo, M.L., Giorgio, A., Roscio, M., Ghezzi, A., Guidi, L., Bartolozzi, M.L., Portaccio, E., De Stefano, N.. Pages: 309-314
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Objective: To evaluate cognitive changes in a cohort of radiologically isolated syndromes (RIS) suggestive of multiple sclerosis (MS) and to assess their relationship with quantitative magnetic resonance (MR) measures such as white matter (WM), lesion loads, and cerebral atrophy.Methods: We assessed the cognitive performance in a group of 29 subjects with RIS recruited from 5 Italian MS centers and in a group of 26 patients with relapsing-remitting MS (RRMS). A subgroup of 19 subjects with RIS, 26 patients with RRMS, and 21 healthy control (HC) subjects also underwent quantitative MR assessments, which included WM T1 and T2 lesion volumes and global and cortical brain volumes.Results: Cognitive impairment of the same profile as that of RRMS was found in 27.6% of our subjects with RIS. On MR scans, we found comparable levels of lesion loads and brain atrophy in subjects with RIS and well-established RRMS. In subjects with RIS, high T1 lesion volume ([rho] = 0.526, p = 0.025) and low cortical volume ([rho] = -0.481, p = 0.043) were associated with worse cognitive performance.Conclusions: These findings emphasize the importance of including accurate neuropsychological testing and quantitative MR metrics in subjects with RIS suggestive of MS. They can provide a better characterization of these asymptomatic subjects, potentially useful for diagnostic and therapeutic decisions.(C)2012 American Academy of Neurology
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a randomized trial of decision-making in asymptomatic carotid stenosis.
- Silver, B., Zaman, I.F., Ashraf, K., Majed, Y., Norwood, E.M., Schuh, L.A., Smith, B.J., Smith, R.E., Schultz, L.R.. Pages: 315-321
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Objective: We sought to evaluate whether different presentation formats, presenter characteristics, and patient characteristics affect decision-making in asymptomatic carotid stenosis.Methods: Subjects included individuals presenting to a neurology clinic. Participants included those over age 18 without known carotid stenosis. Subjects were randomized to a 30-second video with 1 of 5 presentation formats (absolute risk, absolute event-free survival, annualized absolute risk, relative risk, and a qualitative description) delivered by 1 of 4 presenter physicians (black woman, white woman, black man, white man). Subjects then completed a one-page form regarding background demographics and their decision regarding treatment choice.Results: A total of 409 subjects watched the video and completed the survey. Overall, 48.4% of subjects chose surgery. Presentation format strongly predicted choice of surgery (qualitative [64%], relative risk [63%], absolute risk [43%], absolute event-free survival [37%], and annualized absolute risk [35%], p < 0.001). There was a trend for younger age (mean age 52 vs 55, p = 0.054), male gender (53% vs 45%, p = 0.08), and advanced education (42% for high school education or less vs 52% for more than high school education, p = 0.052) to predict surgery choice. Gender and race of presenter, and race of subject, had no influence on the choice of treatment.Conclusions: Presentation format (information framing) strongly determines patient decision-making in asymptomatic carotid stenosis. Subject age, gender, and education level may also influence the decision. Clinicians should consider the influence of these variables when counseling patients.(C)2012 American Academy of Neurology
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linking mri to daily life experience: the example of poststroke depression.
- Lassalle-Lagadec, S., Allard, M., MD, PhD, Dilharreguy, B., Schweitzer, P., Swendsen, J., Sibon, I., MD, PhD. Pages: 322-325
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Objective: The state-of-the-art tools of neurology, in particular modern neuroimaging techniques, have yet to benefit from the revolution in mobile technologies that provide new insights into the mechanisms underlying clinical syndromes. This study demonstrates the manner in which mobile technologies may provide information that is complementary to MRI data, using the illustration of poststroke depression.Methods: MRI examinations were provided to 15 stroke patients, followed by computerized ambulatory monitoring of daily life experiences over 1 week.Results: The occurrence of daily life events was significantly associated with the intensity of positive affect during the ambulatory monitoring period. This emotional reactivity was also significantly associated with functional connectivity in brain regions linked with the risk of depression 3 months following stroke.Conclusions: Novel mobile technologies provide information that is inaccessible to hospital-based tests, and allow for more complete investigations of disorder expression and etiology.(C)2012 American Academy of Neurology
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comment: mobile technology in neurology.
- Chabrol, Henri, MD, PhD, Harrer, Judith. Pages: 323
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cerebral microbleeds are associated with worse cognitive function: the rotterdam scan study.
- Poels, M.M.F., Ikram, M.A., MD, PhD, van der Lugt, A., MD, PhD, Hofman, A., MD, PhD, Niessen, W.J., Krestin, G.P., MD, PhD, Breteler, M.M.B., MD, PhD, Vernooij, M.W., MD, PhD. Pages: 326-333
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Objective: Cerebral microbleeds are frequently found in the general elderly population and may reflect underlying vascular disease, but their role in cognitive function is unknown.Methods: We investigated the association between cerebral microbleeds and performance in multiple cognitive domains in 3,979 persons without dementia (mean age, 60.3 years). Mini-Mental State Examination (MMSE) score and neuropsychological tests were used to assess global cognition and the following cognitive domains: memory, information processing speed, executive function, and motor speed. We used number of microbleeds as continuous variable, and additionally distinguished between persons with no microbleeds, 1 microbleed, 2-4 microbleeds, and >=5 microbleeds. The association of microbleeds with different cognitive domains was estimated using linear regression models. Additional adjustments were made for vascular risk factors, brain atrophy, and other imaging markers of cerebral small vessel disease. We stratified analyses by location of microbleeds.Results: A higher number of microbleeds was associated with lower MMSE score and worse performance on tests of information processing speed and motor speed. When analyzed per category, presence of 5 or more microbleeds was associated with worse performance in all cognitive domains, except memory. These associations were most robust in participants with strictly lobar microbleeds, whereas after additional adjustments associations disappeared for deep or infratentorial microbleeds.Conclusions: Presence of numerous microbleeds, especially in a strictly lobar location, is associated with worse performance on tests measuring cognitive function, even after adjustments for vascular risk factors and other imaging markers of small vessel disease. These results suggest an independent role for microbleed-associated vasculopathy in cognitive impairment.(C)2012 American Academy of Neurology
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genetic variation at cr1 increases risk of cerebral amyloid angiopathy.
- Biffi, A., Shulman, J.M., MD, PhD, Jagiella, J.M., MD, PhD, Cortellini, L., Ayres, A.M., Schwab, K., Brown, D.L., MD, MSc, Silliman, S.L., Selim, M., Worrall, B.B., MD, MSc, Meschia, J.F., Slowik, A., MD, PhD, De Jager, P.L., MD, PhD, Greenberg, S.M., MD, PhD, Schneider, J.A., Bennett, D.A., Rosand, J., MD, MSc. Pages: 334-341
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Objective: Accumulated evidence suggests that a variant within the CR1 gene (single nucleotide polymorphism rs6656401), known to increase risk for Alzheimer disease (AD), influences [beta]-amyloid (A[beta]) deposition in brain tissue. Given the biologic overlap between AD and cerebral amyloid angiopathy (CAA), a leading cause of intracerebral hemorrhage (ICH) in elderly individuals, we investigated whether rs6656401 increases the risk of CAA-related ICH and influences vascular A[beta] deposition.Methods: We performed a case-control genetic association study of 89 individuals with CAA-related ICH and 280 individuals with ICH unrelated to CAA and compared them with 324 ICH-free control subjects. We also investigated the effect of rs6656401 on risk of recurrent CAA-ICH in a prospective longitudinal cohort of ICH survivors. Finally, association with severity of histopathologic CAA was investigated in 544 autopsy specimens from 2 longitudinal studies of aging.Results: rs6656401 was associated with CAA-ICH (odds ratio [OR] = 1.61, 95% confidence interval [CI] 1.19-2.17, p = 8.0 x 10-4) as well as with risk of recurrent CAA-ICH (hazard ratio = 1.35, 95% CI 1.04-1.76, p = 0.024). Genotype at rs6656401 was also associated with severity of CAA pathology at autopsy (OR = 1.34, 95% CI 1.05-1.71, p = 0.009). Adjustment for parenchymal amyloid burden did not cancel this effect, suggesting that, despite the correlation between parenchymal and vascular amyloid pathology, CR1 acts independently on both processes, thus increasing risk of both AD and CAA.Conclusion: The CR1 variant rs6656401 influences risk and recurrence of CAA-ICH, as well as the severity of vascular amyloid deposition.(C)2012 American Academy of Neurology
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the incidence of mci differs by subtype and is higher in men: the mayo clinic study of aging.
- Roberts, R.O., MB ChB, MS, Geda, Y.E., MD, MSc, Knopman, D.S., Cha, R.H., Pankratz, V.S., Boeve, B.F., Tangalos, E.G., Ivnik, R.J., Rocca, W.A., MD, MPH, Petersen, R.C., PhD, MD. Pages: 342-351
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Objective: Although incidence rates for mild cognitive impairment (MCI) have been reported, few studies were specifically designed to measure the incidence of MCI and its subtypes using published criteria. We estimated the incidence of amnestic MCI (aMCI) and nonamnestic MCI (naMCI) in men and women separately.Methods: A population-based prospective cohort of Olmsted County, MN, residents ages 70-89 years on October 1, 2004, underwent baseline and 15-month interval evaluations that included the Clinical Dementia Rating scale, a neurologic evaluation, and neuropsychological testing. A panel of examiners blinded to previous diagnoses reviewed data at each serial evaluation to assess cognitive status according to published criteria.Results: Among 1,450 subjects who were cognitively normal at baseline, 296 developed MCI. The age- and sex-standardized incidence rate of MCI was 63.6 (per 1,000 person-years) overall, and was higher in men (72.4) than women (57.3) and for aMCI (37.7) than naMCI (14.7). The incidence rate of aMCI was higher for men (43.9) than women (33.3), and for subjects with <=12 years of education (42.6) than higher education (32.5). The risk of naMCI was also higher for men (20.0) than women (10.9) and for subjects with <=12 years of education (20.3) than higher education (10.2).Conclusions: The incidence rates for MCI are substantial. Differences in incidence rates by clinical subtype and by sex suggest that risk factors for MCI should be investigated separately for aMCI and naMCI, and in men and women.(C)2012 American Academy of Neurology
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functional integration of parietal lobe activity in early alzheimer disease.
- Jacobs, H.I.L., Van Boxtel, M.P.J., MD, PhD, Heinecke, A., Gronenschild, E.H.B.M., Backes, W.H., Ramakers, I.H.G.B., Jolles, J., Verhey, F.R.J., MD, PhD. Pages: 352-360
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Objectives: Parietal lobe dysfunction is an important characteristic of early Alzheimer disease (AD). Functional studies have shown conflicting parietal activation patterns indicative of either compensatory or dysfunctional mechanisms. This study aimed at examining activation differences in early AD using a visuospatial task. We focused on functional characteristics of the parietal lobe and examined compensation or disconnection mechanisms by combining a fMRI task with effective connectivity measures from Granger causality mapping (GCM).Methods: Eighteen male patients with amnestic mild cognitive impairment (aMCI) and 18 male cognitively healthy older individuals were given a mental rotation task with different rotation angles.Results: There were no behavioral group differences on the fMRI task. Separate measurements at each angle revealed widespread activation group differences. More temporal and parietal activation in the higher angle condition was observed in patients with aMCI. The parametric modulation, which identifies regions associated with increasing angle, confirmed these results. The GCM showed increased connectivity within the parietal lobe and between parietal and temporal regions in patients with aMCI. Decreased connectivity was found between the inferior parietal lobule and posterior cingulate gyrus. Connectivity patterns correlated with memory performance scores in patients with aMCI.Conclusions: Our results demonstrate increased effective temporoparietal connectivity in patients with aMCI, while maintaining intact behavioral performance. This might be a compensational mechanism to counteract a parietal-posterior cingulate gyrus disconnection. These findings highlight the importance of connectivity changes in the pathophysiology of AD. In addition, effective connectivity may be a promising method for evaluating interventions aimed at the promotion of compensatory mechanisms.(C)2012 American Academy of Neurology
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| Clinical/Scientific Notes |
prominent 5-18 hz oscillations in the pallidal-thalamic circuit in secondary dystonia.
- Tsang, E.W., Hamani, C., MD, PhD, Moro, E., MD, PhD, Mazzella, F., Lozano, A.M., MD, PhD, Yeh, I.J., Chen, R., MBBChir, MSc. Pages: 361-363
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| Neuroimages |
muscle mri in trpv4-related congenital distal sma.
- Astrea, G., Brisca, G., Fiorillo, C., MD, PhD, Valle, M., Tosetti, M., Bruno, C., MD, PhD, Santorelli, F.M., Battini, R., MD, PhD. Pages: 364-365
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| Resident and Fellow Section |
clinical reasoning: a 33-year-old woman with severe postpartum occipital headaches.
- Maalouf, Nancy, Harik, Sami. Pages: 366-369
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| Writeclick: Editor's Choice |
ultrasonographic detection of fasciculations markedly increases diagnostic sensitivity of als.
- Boekestein, W.A., Schelhaas, H.J., van Dijk, J.P., Kleine, B.U., Zwarts, M.J.. Pages: 370-371
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immune reconstitution inflammatory syndrome in natalizumab-associated pml.
- Hellwig, Kerstin, Kleiter, Ingo, Gold, Ralf. Pages: 371
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| Correction |
prion-1 scales analysis supports use of functional outcome measures in prion disease.
Pages: 371
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| Resident and Fellow Section |
child neurology: paroxysmal stiffening, upward gaze, and hypotonia: hallmarks of sepiapterin reductase deficiency.
- Dill, P., Wagner, M., Somerville, A., Thony, B., Blau, N., Weber, P.. Pages: e29-e32
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teaching neuroimages: distinct neuroimaging features of fucosidosis.
- Jain, P., Ramesh, K., Mohamed, A., Kumar, A., Gulati, S.. Pages: e33
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| Patient Page |
factors influencing medical decision-making.
- Ashman, Eric. Pages: e34-e35
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