Cases reported "Dementia, Vascular"

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31/128. Diffusion-weighted magnetic resonance imaging in early stage of 5-fluorouracil-induced leukoencephalopathy.

    We report a case of 5-fluorouracil (5-FU)-induced leukoencephalopathy in which magnetic resonance imaging (MRI) of the brain, including diffusion-weighted imaging (DWI), was performed serially. The initial T2-weighted and FLAIR images showed diffuse mild hyperintensity in bilateral deep cerebral white matter and corpus callosum, which on T1WI appeared as non-enhanced faint hypointensity. Isotropic DWI disclosed the abnormality as well-conspicuous diffuse hyperintensity with decreased ADC. Serial studies revealed that majority of the abnormal signal intensity on these sequences resolved, and the decreased ADC values approached normal. Some hyperintensity remained in the deep cerebral white matter and the splenium, but no further significant ADC change after normalization was noted. Measurement of ADC along the three orthogonal directions showed the presence of directional dependence of diffusion throughout the length of study. These findings suggest that early stage of 5-FU-induced leukoencephalopathy is associated with reversible restricted diffusion and preservation of anisotropy. Diffusion-weighted imaging may be useful for the diagnosis. ( info)

32/128. Subcortical gray matter N-acetylaspartate reduction in two cases of vascular dementia.

    Many of the previous studies of vascular dementia using proton magnetic resonance (MR) spectroscopy had been carried out on white matter. However, no proton spectroscopic data of the subcortical gray matter are available in such disease. We report two cases suffering from vascular dementia, with an unilateral N-acetylaspartate (NAA) decrease on subcortical gray matter. This significant reduction in NAA ratios was associated with an increase of choline on the ipsilateral centrum semiovale. We discuss the pathophysiology of these cases. ( info)

33/128. radiation leukoencephalopathy associated with moderate hydrocephalus: intracranial pressure monitoring and results of ventriculoperitoneal shunting.

    Delayed neurological sequelae of radiotherapy have several manifestations; leukoencephalopathy is one of the most common. Pathogenetic relationships between radiation leukoencephalopathy and other findings of diffuse radiation injury (brain atrophy and progressive ventriculomegaly) are not well defined. Moreover, no guidelines have been established for the treatment of hydrocephalus when associated with radiation leukoencephalopathy. Our study reports intracranial pressure (ICP) monitoring in two patients with radiation leukoencephalopathy with moderate hydrocephalus. High intraventricular mean pressure and high peaks were found, and marked improvement of clinical status after shunting was achieved. This study, although restricted to only two patients, shows that ventriculoperitoneal shunting insertion is useful in radiation-induced hydrocephalus, when ICP monitoring detects high mean pressure. A hypothesis is advanced concerning radiation-induced hydrocephalus with high ICP, emphasizing periventricular astrocytosis and its connections with cerebral compliance. ( info)

34/128. Proton MR spectroscopy demonstration of taurine peaks in megalencephalic leukoencephalopathy with cysts.

    taurine is an amino acid. It has roles in neurotransmitter activities, facilitates synaptic connections, and possesses cyto-protective properties. Normally, it is invisible on proton MR spectroscopy acquired at low field strengths (i.e. 1.5T). In a patient with megalencephalic leukoencephalopathy with cysts (MLC), distinct taurine peaks centered at 3.35ppm were found on hybrid-CSI spectroscopy obtained at 1.5T with a long TE value (i.e. TE=135ms). This suggested increased concentrations of this metabolite in MLC. In this leukoencephalopathy taurine may be linked to a metabolic disturbance related with neurotransmitters associated with a disturbance in synaptic connections, and cyto-protective mechanisms. Further spectroscopic and clinical studies are required to evaluate this observation. ( info)

35/128. Megalencephalic leukoencephalopathy with subcortical cysts in an adult: quantitative proton MR spectroscopy and diffusion tensor MRI.

    A 37-year-old macrocephalic woman was investigated for increasing gait disturbance due to longstanding spasticity and ataxia. MRI showed widespread bilateral increase in signal from cerebral white matter on T2-weighted images. Numerous subcortical cysts were visible in anterior-temporal and parietal regions. These clinical and neuroradiological features are those of megalencephalic leukoencephalopathy with subcortical cysts (MLC), a recently delineated white-matter disease with onset in childhood. Quantitative localised proton MR spectroscopy of white matter revealed marked reduction of N-acetylaspartate, creatine, and choline with normal values for myo-inositol, consistent with axonal loss and astrocytic proliferation. diffusion tensor imaging showed an increased apparent diffusion coefficient and reduced anisotropy in affected white matter pointing to reduced cell density with an increased extracellular space. These findings are in line with histological changes alterations known to occur in MLC. ( info)

36/128. Cerebral angiitis mimicking posterior leukoencephalopathy.

    Posterior leukoencephalopathy typically denotes neurotoxicity from immunosuppressive agents, malignant hypertension or eclampsia. It has not been documented in central nervous system angiitis. We present three cases associated with isolated cerebral angiitis after review of all cases of isolated CNS angiitis from 1998 to 2000. Additional lesions beyond the posterior occipital lesions became evident in two cases. A cerebral angiogram and possibly brain biopsy to detect isolated angiitis should be considered in patients with posterior leukoencephalopathy of unknown etiology. ( info)

37/128. Postpartum posterior leukoencephalopathy syndrome.

    In this report we are presenting three patients of posterior leukoencephalopathy syndrome developing in postpartum period. Two of these patients had persistent imaging abnormalities in posterior parietal and occipital regions leading to focal atrophy of brain along with permanent cortical blindness and recurrent seizures. In both the patients the syndrome was either unrecognized, or remained untreated on initial presentation. In third patient also the syndrome was not recognized for 10 days, initial clinical manifestations and computed tomographic (CT) abnormalities remained unchanged even after two months. Failure to early recognition and treatment can produce permanent brain damage and syndrome of posterior leukoencephalopathy may become irreversible. ( info)

38/128. Differential diagnosis of dementia: clinical examination and laboratory assessment.

    Recent breakthroughs in putative disease-modifying interventions for Alzheimer's disease (AD) underscore the urgency of making the earliest possible diagnosis. In the absence of a convenient and reliable laboratory test for AD, the clinical assessment is still the cornerstone of the diagnostic approach. This article provides a basis for conducting an assessment within the realities of a busy clinical practice for patients complaining of cognitive decline. The assessment will enable the clinician to diagnose the earliest manifestation of AD. ( info)

39/128. Primary angioplasty in cadasil.

    We report an acute coronary event in a young patient suffering from cerebral autosomal dominant arteriopathy with sub-cortical infarcts and leucoencephalopathy (cadasil) successfully treated by primary angioplasty and direct stenting. Coronary involvement and pathophysiology of this genetic disorder is discussed. ( info)

40/128. Acute leukoencephalopathy after inhalation of a single dose of heroin.

    We describe extended and repeat magnetic resonance (MR) examinations in the case of a 16-year-old male who developed acute left-sided sensorimotor hemiplegia after a single dose of inhaled heroin. MRI revealed symmetrical hyperintense signals in T 2 -weighted images and massive diffusion disorders in the diffusion weighted images predominantly in parieto-occipital subcortical white matter and both ventral globi pallidi with preservation of U fibers and no brain oedema. MR spectroscopy data were compatible with combined hypoxic and mitochondrial damage resulting in axonal injury without demyelination. Normal values and variations had been obtained from spectra of five age-matched subjects. This is the first reported MR follow-up study of leukoencephalopathy occurring acutely after a first inhaled dose of heroin. We postulate that toxic spongiform leukoencephalopathy in heroin addicts may be the outcome of a complex mechanism directly triggered by heroin and causing mitochondrial as well as hypoxic injury in specific and limited areas of white matter. ( info)
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