DOCSLIB.ORG

Leukoaraiosis and Cause of Death: a Five Year J Neurol Neurosurg Psychiatry: First Published As 10.1136/Jnnp.58.5.586 on 1 May 1995

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Leukoaraiosis and Cause of Death: a Five Year J Neurol Neurosurg Psychiatry: First Published As 10.1136/Jnnp.58.5.586 on 1 May 1995 58656ournal ofNeurology, Neurosurgery, and Psychiatry 1995;58:586-589 Leukoaraiosis and cause of death: a five year J Neurol Neurosurg Psychiatry: first published as 10.1136/jnnp.58.5.586 on 1 May 1995. Downloaded from follow up S Tarvonen-Schr6der, T Kurki, I Riiha, L Sourander Abstract researchers disagree.' 17 Hypoperfusion associ- The causes of death of 127 patients, who ated with IA in a number of perfusion stud- had undergone CT examination of the ies" 18 may be not only causal, but may also be brain in 1989, were investigated. The CT a consequence of it." As well as the common was re-evaluated. Twenty five patients neuropathological finding of hyaline vascular were excluded because of pathological stenosis in association with LA,"78 amyloid findings on CT other than leukoaraiosis angiopathy has been considered a possible (LA), infarction, or their combination or, pathogenetic basis for it14 18 19-but not unani- because of a specific known aetiology for mOUsly.3 7 8 LA. Ofthe remaining 102 patients, 25 had To test further the significance of pure LA, 18 had pure infarction, 37 had leukoaraiosis on CT, we investigated its asso- LA combined with infarction (cLA), and ciation with the cause of death, especially 22 had a normal CT. The mean time from vascular disease. between the CT and death was 1-8 (SD 1.5) years. A vascular cause of death was clearly associated with LA and with the Patients and methods severity ofLA. Patients with pure LA had PATIENTS a vascular cause ofdeath as often as those In the geriatric department of Turku City with pure infarction and those with LA Hospital, CT examination of the brain for combined with infarction. These groups various reasons was performed in 253 patients differed significantly from each other from January to December 1989. It was stan- when comparing the occurrence of cere- dard practice in the department that a neurol- brovascular, cardiovascular and other ogist examined patients with neurological or vascular causes of death. The results sug- mental problems and decided whether CT gest that LA on CT is more likely to be examination of the brain was necessary. It was associated with a cardiovascular cause of possible to obtain sufficient data on 208 death, and pure infarction is more often patients, of whom 25 were excluded because associated with a cerebrovascular death. of a specific known aetiology for LA or pathology on CT other than LA, or infarction, (T Neurol Neurosurg Psychiatry 1995;58:586-589) or their combination. At the time of this http://jnnp.bmj.com/ investigation (May 1994) 102 patients had died. Of these 62 had LA; 25 as the sole Keywords: cause of death; computed tomography; pathological finding on CT-that is, pure LA leukoaraiosis; vascular death and 37 with LA combined with infarction- that is, combined LA. Of the 40 patients who Leukoaraiosis (LA) is a non-specific radiologi- did not have LA lesions, 18 had infarction as cal in the cerebral white matter shown by the sole pathological finding on CT, (pure sign on September 25, 2021 by guest. Protected copyright. CT or MRI.' The clinical relevance and infarction) and 22 had a normal CT finding. aetiopathogenesis of these white matter The mean time between the CT and death lesions are far from clear. They may be was 1-8 (SD 1.5) years. heterogeneous in origin, an end stage due to Department of or a of a CLINICAL INFORMATION Geriatrics, University various mechanisms,2 manifestation of Turku, Turku, vascular process,2 4but most likely not an end The hospital records including the detailed Finland point of it.3-5 LA can be found in normal medical history of the patients, death certifi- S Tarvonen-Schroder and in those with no evidence cates, and necropsy reports were interpreted I Riiiha elderly subjects2 L Sourander of vascular disease6 as well as in pathological by the same neurologist (ST-S) without Department of conditions. In some studies LA has been asso- knowing whether LA was present, but know- Radiology, Turku ciated with various cerebrovascular risk fac- ing other findings on CT. Necropsies were University Hospital, tors2 including both hypertension2 5 and done on 47 (46%) of the 102 patients. The Turku, Finland T Kurki hypotension7-9; LA itself has been found to be diagnosis of dementia was based on DMS-III- a risk factor for future for develop- R.20 The patients were divided into four Correspondence to: strokes,'10-2 Dr S Tarvonen-Schroder, ment of clinically relevant cerebrovascular dis- groups: (a) no dementia; (b) Alzheimer's dis- Department of Geriatrics, ease in accordance with the University of Turku, ease,'1'3 and for poor overall prognosis.'214 diagnosed Kunnallissairaalantie 20, Causes that have been suggested for LA NINCDS-ADRDA criteria for probable Fin-20700 Turku, Finland. include Wallerian degeneration secondary to Alzheimer's disease21; (c) vascular dementia Received 12 August 1994 with the NINDS- and in revised form neuronal death in association with diagnosed in accordance 24 November 1994. Alzheimer's disease'5 and also in association AIREN criteria22 for "probable VAD" and the Accepted 31 January 1995 with cortical infarction,'6 but other ischaemic score of Hachinski23; (d) other Leukoaraiosis and cause ofdeath: afive yearfollow up 587 Table I Demographic data on patients with pure LA (pLA), pure infarction (pIn]), atrophies with a distribution corresponding to J Neurol Neurosurg Psychiatry: first published as 10.1136/jnnp.58.5.586 on 1 May 1995. Downloaded from combined LA and infarction (cLA), and a normal CTfinding (nCT) major brain arteries were considered postin- pLA pInf cLA nCT P value farction lesions. To simplify matters, the dif- (n = 25) (n = 18) (n = 37) (n = 22) ferent types of infarctions (for example, Mean age (y (SD)) 85-9 (1-3) 75-2 (2-1) 82-5 (1-0) 73-1 (1-6) 0-0000 lacunes and large cortical infarcts) were not Sex (women) 20 (80) 8 (44) 26 (70) 17 (77) NS Cognitive status: differentiated even though they may have No dementia 6 (24) 8 (44) 6 (16) 8 (36) NS been consequences of different pathophysio- AD 2 (8) 0 (0) 2 (5) 4 (18) NS VAD 14 (56) 10 (56) 29 (78) 5 (23) 0-0006 logical processes. Other dementia 3 (12) 0 (0) 0 (0) 5 (23) 0-0073 Except for age, values are numbers of patients (%). STATISTICAL ANALYSIS AD = probable Alzheimer's disease; VAD = probable vascular dementia or combined vascular The Mann-Whitney test was used for com- and degenerative dementia. parison of means of severity (extent) of LA between the groups with pure LA and com- dementia (aetiology other than Alzheimer's bined LA. The Kruskall-Wallis test was used disease or vasicular dementia-for instance, for multiple comparisons of means of the alcoholism, previous trauma, or schizophre- Hachinski score among the four study groups. nia). The diagnosis of the primary cause of A one way analysis of variance (ANOVA) test death was based on the International was used for multiple comparisons of mean Statistical Classification of Diseases, Injuries, ages at death among the four groups, and a t and Causes of Death (ICD-9).24 test with Bonferroni correction for paired comparisons. Associations between categorial COMPUTED TOMOGRAPHY variables were analysed with Pearson's X2 test. Findings from CT were interpreted by the When the counts in the cells were less than 5, same neuroradiologist (TK), who was not Fisher's two tailed exact test was used. aware of the clinical data. A Toshiba 80A Associations between categorical (causes of scanner had been used in all examinations. death) and continuous (age at death) variables The CT had been obtained from the base to were analysed by dichotomous and multino- the vertex ofthe brain. The slice thickness was mial logistic regression analysis. The limit of 10 mm with the exception of the base of the significance used was P < 0 05. brain where it was 5 mm. The evaluation was done from hard copy x ray films. Bilateral symmetric confluent areas with Results reduced CT attenuation contiguous with the Table 1 shows demographic data on the margins of the lateral ventricles were desig- patients in the four different study groups; LA nated as LA lesions. Areas with decreased (both pure LA and combined LA as com- attenuation of the white matter could be pared with normal CT) was strongly associ- located at the margins of the frontal and ated with age, but pure infarction was not. occipital horns of the lateral ventricles or they The cause of death, however, vascular or non- may have extended towards the centrum vascular on the one hand and the type of vas- semiovale. Lesions could be irregular or cular death (cerebrovascular, cardiovascular, patchy but mostly they tended to be uniform and other vascular) on the other were not and diffuse. associated with age or with sex. Thus adjust- http://jnnp.bmj.com/ The distribution of LA was divided into ment for age or sex among the different three areas: frontal, central, and occipital. groups was not needed. The extent of LA in these areas was graded on Table 2 shows that a vascular cause of visual impression as follows: 0, no LA; 1, death was clearly associated with pure LA and under 1/4 of the area; 2, 1/4-1/2 of the area, the severity of pure LA. Patients with severe and 3, over 1/2 of the area. The severity of LA pure LA had a vascular cause of death as often was graded from 1 to 9 on the basis of the as those with pure infarction.
Load more

Recommended publications
  • Serial Magnetic Resonance Imaging Changes of Pseudotumor Lesions In
    Yan et al. BMC Neurol (2021) 21:219 https://doi.org/10.1186/s12883-021-02250-4 CASE REPORT Open Access Serial magnetic resonance imaging changes of pseudotumor lesions in retinal vasculopathy with cerebral leukoencephalopathy and systemic manifestations: a case report Yuying Yan1, Shuai Jiang1, Ruilin Wang2, Xiang Wang3, Peng Li3* and Bo Wu1* Abstract Background: Retinal vasculopathy with cerebral leukoencephalopathy and systemic manifestations (RVCL-S) is an adult-onset rare monogenic microvasculopathy. Its typical neuroimaging features are punctate white matter lesions or pseudotumor alterations. RVCL-S is often under-recognized and misdiagnosed because of its rarity and similar imaging manifestations to multiple sclerosis or brain malignant mass. Case presentation: Here we report a case of a 36-year-old Chinese man who developed multiple tumefactive brain lesions spanning over two years leading to motor aphasia, cognitive decline, and limb weakness. He also presented with slight vision loss, and fundus fuorescein angiography indicated retinal vasculopathy. He underwent brain biopsies twice and showed no evidence of malignancy. Given the family history that his father died of a brain mass of unclear etiology, RVCL-S was suspected, and genetic analysis confrmed the diagnosis with a heterozygous insertion mutation in the three-prime repair exonuclease 1 gene. He was given courses of corticosteroids and cyclophospha- mide but received little response. Conclusions: The present case is one of the few published reports of RVCL-S with two-year detailed imaging data. Serial magnetic resonance images showed the progression pattern of the lesions. Our experience emphasizes that a better understanding of RVCL-S and considering it as a diferential diagnosis in patients with tumefactive brain lesions may help avoid unnecessary invasive examinations and make an earlier diagnosis.
    [Show full text]
  • Radiologically Isolated Syndrome: a Review for Neuroradiologists
    REVIEW ARTICLE Radiologically Isolated Syndrome: A Review for Neuroradiologists M. Hosseiny, S.D. Newsome, and D.M. Yousem ABSTRACT SUMMARY: Radiologically isolated syndrome refers to an entity in which white matter lesions fulfilling the criteria for multiple sclerosis occur in individuals without a history of a clinical demyelinating attack or alternative etiology. Since its introduction in 2009, the diagnostic criteria of radiologically isolated syndrome and its clinical relevance have been widely debated by neu- rologists and radiologists. The aim of the present study was to review the following: 1) historical evolution of radiologically iso- lated syndrome criteria, 2) clinical and imaging findings in adults and children with radiologically isolated syndrome, 3) imaging features of patients with radiologically isolated syndrome at high risk for conversion to MS, and 4) challenges and controversies for work-up, management, and therapeutic interventions of patients with radiologically isolated syndrome. ABBREVIATIONS: CIS ¼ clinically isolated syndrome; DIS ¼ dissemination in space; DIT ¼ dissemination in time; MAGNIMS ¼ Magnetic Resonance Imaging in MS; RIS ¼ radiologically isolated syndrome; RRMS ¼ relapsing-remitting multiple sclerosis; CADASIL ¼ cerebral autosomal dominant arteriopathy with sub- cortical infarcts and leukoencephalopathy; ADEM ¼ acute disseminated encephalomyelitis adiologically isolated syndrome (RIS) refers to an entity in patients are being evaluated for headache, trauma, or nonspecific Rwhich brain or spine MR
    [Show full text]
  • A Diffusion Tensor Magnetic Resonance Imaging Study of Brain Tissue from Patients with Migraine M a Rocca, B Colombo, M Inglese, M Codella, G Comi, M Filippi
    501 J Neurol Neurosurg Psychiatry: first published as 10.1136/jnnp.74.4.501 on 1 April 2003. Downloaded from SHORT REPORT A diffusion tensor magnetic resonance imaging study of brain tissue from patients with migraine M A Rocca, B Colombo, M Inglese, M Codella, G Comi, M Filippi ............................................................................................................................. J Neurol Neurosurg Psychiatry 2003;74:501–503 PATIENTS AND METHODS Objective: To measure in vivo, using diffusion tensor mag- We studied 34 patients (31 women and three men; mean age netic resonance imaging (DT-MRI) the extent of pathologi- 35.2 years, range 18–55 years; mean duration of the disease cal damage of normal appearing brain tissue (NABT) from 13.6 years, range 1–40 years; mean number of episodes per patients with migraine. year 44.6, range 12–70) with migraine.10 All possible alterna- Methods: Dual echo and DT-MRI scans of the brain were tive diagnoses were carefully excluded.10 There were 28 acquired from 34 patients with migraine and 17 sex and patients affected by “migraine without aura” and six patients age matched healthy volunteers. Mean diffusivity (MD) affected by “migraine with aura”.10 Patients with hyper- and fractional anisotropy (FA) histograms of the NABT tension, hypercholesteraemia, diabetes mellitus, vascular/ were obtained from all subjects and the histograms’ peak heart diseases, and other major systemic and neurological heights and average NABT MD and FA measured. When conditions were excluded. At the time of the MRI assessment, present, average MD and FA values of T2 visible lesions 11 patients were treated with prophylactic drugs. Seventeen were also measured.
    [Show full text]
  • Increased Tissue Pressure Induces Demyelinated Lesions and Necroses in the Brain
    American Journal of Neuroscience Original Research Paper Increased Tissue Pressure Induces Demyelinated Lesions and Necroses in the Brain 1Helmut Barz, 2Ulrich Barz and 3Almut Schreiber 1Department of Neuropathology, Dietrich-Bonhoeffer Hospital Neubrandenburg, Mecklenburg-West-Pomerania, Germany 2Martin-Luther-Universität Halle-Wittenberg, Halle, Saxony-Anhalt, Germany 3Consultant Occupational Health Physician, Institut Für Arbeits-und Sozialhygiene, Aktiengesellschaft, Dresden, Saxony, Germany Article history Abstract: A general brain edema increases the size of the brain tissue and Received: 08-12-2014 stretches the elastic neuronal and glial fibers. Myelinated fibers are more Revised: 20-01-2015 elastic than unmyelinated fibers. The stretching of the neuronal fibers leads Accepted: 12-03-2015 particular in regions of the white matter or areas surrounded by myelinated fiber tracts to an increased tissue pressure. This physical principle can be Corresponding Author: Helmut Barz the reason for demyelination and tissue necrosis. The higher the tissue Department of Neuropathology, pressure, the lower the blood perfusion. We support the pressure-hypothesis Dietrich-Bonhoeffer Hospital by comparison with well-known pressure related pathologies of the nervous Neubrandenburg, Mecklenburg- system and other organs. One convincing example is the central pontine West-Pomerania, Germany myelinolysis. A general or local tissue edema may lead especially in the Email: [email protected] periventricular and the deep white matter, but also in the cerebellum, the brain stem and the spinal cord to the formation of hypoxemic lesions. In consequence, this could result in diseases like leukoaraiosis, Binswanger encephalopathy, idiopathic intracranial hypertension and Multiple Sclerosis (MS). In cases of brain tissue swelling, capsula-like structures may lead to a rapid increase in tissue pressure within the enclosed areas.
    [Show full text]
  • Multiple Sclerosis
    Original article The Neuroradiology Journal 0(00) 1–6 ! The Author(s) 2018 Multiple sclerosis: High prevalence of the Reprints and permissions: sagepub.co.uk/journalsPermissions.nav ‘central vein’ sign in white matter lesions DOI: 10.1177/1971400918763577 on susceptibility-weighted images journals.sagepub.com/home/neu Gianvincenzo Sparacia1 , Francesco Agnello1, Angelo Gambino1, Martina Sciortino2 and Massimo Midiri1 Abstract Purpose: The aim of this study was to determine the occurrence and distribution of the ‘central vein’ sign in white matter lesions on susceptibility-weighted magnetic resonance images in patients with multiple sclerosis (MS) and cerebral small vessel disease (CSVD). Materials and methods: T2-weighted and fluid-attenuated inversion recovery magnetic resonance images of 19 MS patients and 19 patients affected by CSVD were analysed for the presence and localisation of focal hyperintense white matter lesions. Lesions were subdivided into periventricular or non-periventricular (juxtacortical, subcortical, deep white matter and cerebellar) distributed. The number and localisation of lesions presenting with the central vein sign were recorded and compared between MS and CSVD lesions. Results: A total of 313 MS patients and 75 CSVD lesions were identified on T2-weighted and fluid-attenuated inversion recovery magnetic resonance images. The central vein sign was found in 128 MS lesions (40.9%), and the majority of them (71/128, 55.5%) had a periventricular distribution. The central vein sign was found in 22 out of 75 (29.3%) CSVD lesions, and periventricular distribution was seen in six out of 22 (27.2%) CSVD lesions. The difference in the proportion of white matter hyperintense lesions that presented with the central vein sign on susceptibility-weighted images in patients with MS and CSVD was statistically different, and a significantly higher number of MS patients presented with lesions with the central vein sign compared to CSVD patients.
    [Show full text]
  • White Matter Hyperintensities in Migraine: a Review
    Precision and Future Medicine 2019;3(4):146-157 REVIEW https://doi.org/10.23838/pfm.2019.00128 ARTICLE pISSN: 2508-7940 · eISSN: 2508-7959 White matter hyperintensities in migraine: a review 1 2 1 Mi Ji Lee , Sujin Moon , Chin-Sang Chung 1 Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea 2 CHA University School of Medicine, Seongnam, Korea Received: October 6, 2019 Revised: November 28, 2019 Accepted: December 3, 2019 ABSTRACT Migraine is a neurological disorder characterized by recurrent spells of headache ac- Corresponding author: Mi Ji Lee companied by brain symptoms such as nausea, vomiting, photophobia, and phono- Department of Neurology, phobia. White matter hyperintensity (WMH) is the most frequent radiological abnormal- Samsung Medical Center, ity observed in migraineurs. Older studies have reported that the prevalence of WMH is Sungkyunkwan University about 30% in migraineurs, while latest studies using advanced technology show that School of Medicine, 81 Irwon- WMHs are present in about 70% of young (age < 50 years), vascular risk factor-free pa- ro, Gangnam-gu, Seoul 06351, tients with migraine. Population-based studies on elderlies reported conflicting results Korea on the association between migraine and WMH, but deep WMHs were greater in studies Tel: +82-2-3410-3599 of the younger population. Data are also conflicting on whether headache characteris- E-mail: [email protected] tics, migraine type, disease duration, or headache frequency are associated with WMH. Current evidence suggests that a greater deep WMH burden is associated with intracra- nial and extracranial vascular function. The clinical implication of WMH has not been well studied in relation to migraine, but it is generally not associated with cognitive dys- function in patients with migraine.
    [Show full text]
  • Silent Tumefactive Demyelinating Lesions and Radiologically Isolated Syndrome
    Hindawi Case Reports in Neurological Medicine Volume 2018, Article ID 8409247, 5 pages https://doi.org/10.1155/2018/8409247 Case Report Silent Tumefactive Demyelinating Lesions and Radiologically Isolated Syndrome Ozgul Ekmekci 1 and Cenk Eraslan2 1 Ege University, Faculty of Medicine, Department of Neurology, Izmir, Turkey 2Ege University, Faculty of Medicine, Department of Radiology, Izmir, Turkey Correspondence should be addressed to Ozgul Ekmekci; [email protected] Received 17 August 2018; Accepted 15 November 2018; Published 28 November 2018 Academic Editor: Peter Berlit Copyright © 2018 Ozgul Ekmekci and Cenk Eraslan. Tis is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Demyelinating lesions larger than 2 cm in diameter, with or without edema, are known as tumefactive demyelinating lesions (TDLs). Tey constitute a rare infammatory demyelinating disorder of the central nervous system. TDLs are typically characterized by headaches, cortical symptoms such as aphasia, hemiparesis, hemisensory defcits, seizures, and changes in consciousness. TDLs may occur in patients with or without an established diagnosis of MS or may occur as the initial demyelinating event. Tey may also be observed during follow-up in patients with MS, neuromyelitis optica, acute disseminated encephalomyelitis, or other autoimmune diseases. Diferential diagnosis includes brain tumors, abscess, granulomatous diseases, and vasculitis. In some cases, it may be very difcult to distinguish TDLs from a tumor, such that biopsy might be needed. However, no cases of asymptomatic TDLs have yet been reported in the literature. Hence, in this report, we present a case involving an asymptomatic TDL detected incidentally during magnetic resonance imaging in an 18-year-old man.
    [Show full text]
  • Multiple Sclerosis: Conventional and Advanced MRI Techniques
    SMGr up Multiple Sclerosis: Conventional and Advanced MRI Techniques Shambhu Kumar Sah1, Sanjeet Kumar Shah1, Silin Du1, Ping Yin1, Xiaoqing Shi1 and Yongmei Li1* 1 1 Youyi Road, Yuzhong District, Chongqing 400016, China Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, No. *Corresponding author: Yongmei Li, Department of Radiology, The First Affiliated Hospital China, Tel: +86-23-68899931; Fax: +86-23-68811487; Email: [email protected] of Chongqing Medical University, No. 1 Youyi Road, Yuzhong District, Chongqing 400016, Published Date: January 30, 2016 ABSTRACT Multiple Sclerosis (MS) is an autoimmune disease characterized by recurrent episodes of central nervous system (CNS) demyelination leading to variable clinical outcomes. The latest revision of McDonald’s criteria allow for an earlier diagnosis of MS from a single baseline brain MRI providing improved sensitivity and specificity in the definite diagnosis of MS after and in monitoring the disease course; however, it lacks sensitivity to gray matter lesions and the first clinically isolated syndrome (CIS). Conventional MRI plays a key role in diagnosing diffuse damage throughtout the white matter. Advanced MRI techniques offer new biomarkers more closely linked to the pathological features of the disease, which are likely to improve the understanding of MS pathophysiology. However, the adoption of advanced techniques into clinical research and practice need to be refined and validated due to several limitations. of MS, including the more
    [Show full text]
  • Free PDF Download
    Eur opean Rev iew for Med ical and Pharmacol ogical Sci ences 2016; 20: 1032-1036 Characteristic analysis of white matter lesions in migraine patients with MRI F. HU, Z.-W. QIAN College of Health Information Technology and Management, Shanghai University of Medicine and Health Sciences, Shanghai, China Abstract. – OBJECTIVE: The aim of this riplegia and migraine as the most severe chronicle study is to analyze the characteristics of white functional disorders. Clinically, the pathogenesis matter lesions in abnormal manifestations of of migraine is not clear, and there are several theo - magnetic resonance imaging (MRI) of patients with migraine, and its relationship with migraine. ries proposed, including vascular source theory, PATIENTS AND METHODS: 38 patients, diag - neuron theory, nerve vascular source theory and nosed with migraine were continuously selected so on 3. Currently, there are rare clinical specific as the observation group, while during the same imaging indicators and laboratory examination period, 30 healthy individuals were selected as methods, and magnetic resonance imaging (MRI) the control group. The differences of the fea - is the most frequently used technology in func - tures of MRI of two groups, the ratios of white matter lesions manifestations and the severity tional imaging, which has the advantages of high were compared. resolution, radiation less and no trauma. MRI is RESULTS: The manifestations of MRI in pa - sensitive to lesions in brain tissue and soft tissue, tients with migraine were mainly white matter le - can be quantitatively detected, and is more and sions. The accuracy rate was 86.7%, and the more widely applied clinically 4.
    [Show full text]
  • The Use of the Central Vein Sign in the Diagnosis of Multiple Sclerosis: a Systematic Review and Meta-Analysis
    diagnostics Review The Use of the Central Vein Sign in the Diagnosis of Multiple Sclerosis: A Systematic Review and Meta-analysis 1, 1, 1, 2 Marco Castellaro * , Agnese Tamanti y, Anna Isabella Pisani y, Francesca Benedetta Pizzini , 1, 1, Francesco Crescenzo z and Massimiliano Calabrese z 1 Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, 37134 Verona, Italy; [email protected] (A.T.); [email protected] (A.I.P.); [email protected] (F.C.); [email protected] (M.C.) 2 Department of Diagnostics and Public Health, University of Verona, 37134 Verona, Italy; [email protected] * Correspondence: [email protected] These authors equally contributed to the work. y These authors shared the last-co authorship. z Received: 5 November 2020; Accepted: 26 November 2020; Published: 29 November 2020 Abstract: Background: The central vein sign (CVS) is a radiological feature proposed as a multiple sclerosis (MS) imaging biomarker able to accurately differentiate MS from other white matter diseases of the central nervous system. In this work, we evaluated the pooled proportion of the CVS in brain MS lesions and to estimate the diagnostic performance of CVS to perform a diagnosis of MS and propose an optimal cut-off value. Methods: A systematic search was performed on publicly available databases (PUBMED/MEDLINE and Web of Science) up to 24 August 2020. Analysis of the proportion of white matter MS lesions with a central vein was performed using bivariate random-effect models. A meta-regression analysis was performed and the impact of using particular sequences (such as 3D echo-planar imaging) and post-processing techniques (such as FLAIR*) was investigated.
    [Show full text]
  • Seizures in the Context of Occult Cerebrovascular Disease
    SEIZURES IN THE CONTEXT OF OCCULT CEREBROVASCULAR DISEASE Hedley C.A. Emsley1,2,3* and Laura M. Parkes3 1Department of Neurology, Royal Preston Hospital, Lancashire Teaching Hospitals NHS Foundation Trust, Sharoe Green Lane, Fulwood, Preston, PR2 9HT, UK 2Lancaster Medical School, Lancaster University, Bailrigg, Lancaster, LA1 4YW, UK 3Division of Neuroscience and Experimental Psychology, Faculty of Biology, Medicine and Health, University of Manchester, Stopford Building, Oxford Road, Manchester, M13 9BG, UK *Corresponding author [email protected] Highlights • Occult cerebrovascular disease is an important cause of late-onset seizures and late-onset epilepsy • LOS/LOE are associated with a three-fold increased risk of stroke • ‘Late-onset’ should probably be regarded as being from the fourth decade of life onwards • There may be a disproportionately increased risk of ICH after LOS/LOE • There is a bidirectional relationship between LOE/LOS and cognitive impairment/dementia • There is a pressing need for further research in this field, including epidemiological, natural history and mechanistic studies Abstract There is an important bidirectional relationship between seizures and cerebrovascular disease. Occult cerebrovascular disease (CVD) is an important cause of late-onset seizures (LOS) and late- onset epilepsy (LOE). LOS/LOE are associated with a three-fold increased risk of subsequent clinical stroke. This relationship exists not only in later life, but with ‘late-onset’ seizures or epilepsy occurring from the fourth decade of life onwards. There is an increasing evidence for the importance of hypertension and cerebral small vessel disease in epileptogenesis, but there is a considerable need for further work to elucidate underlying mechanisms.
    [Show full text]
  • Association Between Leukoaraiosis Severity and Functional Outcomes in Patients with Subcortical Infarct
    02 Brain Neurorehabil. 2017 Sep;10(2):e18 https://doi.org/10.12786/bn.2017.10.e18 pISSN 1976-8753·eISSN 2383-9910 Brain & NeuroRehabilitation Clinical Research Association between Leukoaraiosis Severity and Functional Outcomes in Patients with Subcortical Infarct Go Eun Kim, Min Ho Chun, Min Cheol Jang, Kyung Hee Do, Su Jin Choi Received: Jul 6, 2017 Highlights Revised: Sep 21, 2017 Accepted: Sep 26, 2017 • LA is a risk factor for stroke, and in stroke patients, the severity of LA is related to clinical Correspondence to and functional outcomes. Min Ho Chun • In this study, as in previous studies, negative effects of LA on functional outcomes were Department of Rehabilitation Medicine, found in patients with a subcortical infarct. University of Ulsan College of Medicine, Asan • The severity of LA, predicts poor functional outcomes, including in ambulatory function, in Medical Center, 88 Olympic-ro 43-gil, Songpa- the subacute phase after stroke onset. gu, Seoul 05505, Korea. Tel: +82-2-3010-3800 Fax: +82-2-3010-6964 E-mail: [email protected] Copyright © 2017. Korea Society for Neurorehabilitation i 02 Brain Neurorehabil. 2017 Sep;10(2):e18 https://doi.org/10.12786/bn.2017.10.e18 pISSN 1976-8753·eISSN 2383-9910 Brain & NeuroRehabilitation Clinical Research Association between Leukoaraiosis Severity and Functional Outcomes in Patients with Subcortical Infarct Go Eun Kim ,1 Min Ho Chun ,1 Min Cheol Jang ,2 Kyung Hee Do ,3 Su Jin Choi 4 1Department of Rehabilitation Medicine, University of Ulsan College of Medicine, Asan Medical Center,
    [Show full text]