Table of Contents
Perspectives
Genetics Vignette
General Contents
- Hippocampal and Deep Gray Matter Nuclei Atrophy Is Relevant for Explaining Cognitive Impairment in MS: A Multicenter Study
Brain dual-echo, 3D T1-weighted, and double inversion recovery scans were acquired at 3T from 62 patients with relapsing-remitting MS and 65 controls. Focal WM and cortical lesions were identified, and volumetric measures from WM, cortical GM, the hippocampus, and deep GM nuclei were obtained. Compared with those with who were cognitively preserved, patients with MS with cognitive impairment had higher T2 and T1 lesion volumes and a trend toward a higher number of cortical lesions. Significant brain, cortical GM, hippocampal, deep GM nuclei, and WM atrophy was found in patients with MS with cognitive impairment versus those who were cognitively preserved. The authors conclude that hippocampal and deep GM nuclei atrophy are key factors associated with cognitive impairment in MS.
- Intracranial Arteriovenous Shunting: Detection with Arterial Spin-Labeling and Susceptibility-Weighted Imaging Combined
Ninety-two consecutive patients with a known (n = 24) or suspected arteriovenous shunting (n = 68) underwent DSA and brain MR imaging, including arterial spin-labeling/SWI and conventional angiographic MR imaging. DSA showed arteriovenous shunting in 63 of the 92 patients. Interobserver agreement was excellent. In 5 patients, arterial spin-labeling/SWI correctly detected arteriovenous shunting, while the conventional angiographic MR imaging did not. The authors conclude that the combined use of arterial spin-labeling and SWI may be an alternative to contrast-enhanced MRA for the detection of intracranial arteriovenous shunting.
- Endovascular Therapy of M2 Occlusion in IMS III: Role of M2 Segment Definition and Location on Clinical and Revascularization Outcomes
The authors reviewed the impact of revascularization on clinical outcomes in 83 patients with M2 occlusions in the Interventional Management of Stroke III trial according to specific M1–M2 segment anatomic features. AnmRS 0–2 outcome was associated with reperfusion for M2 trunk (n = 9) or M2 division (n = 42) occlusions, but not for M2 branch occlusions (n = 28). Of the 83 participants with M2 occlusion who underwent endovascular therapy, 41.0% achieved mRS 0–2 at 90 days, including 46.6% with modified TICI 2–3 reperfusion compared with 26.1% with modified TICI 0–1 reperfusion. They conclude that mRS 0–2 at 90 days was dependent on reperfusion for M2 trunk but not for M2 branch occlusions in IMS III.
- Emergent Endovascular Management of Long-Segment and Flow-Limiting Carotid Artery Dissections in Acute Ischemic Stroke Intervention with Multiple Tandem Stents
The authors investigated the role of emergent endovascular stenting of long-segment carotid dissections in the acute ischemic stroke setting in 15 patients. They specifically evaluated long-segment carotid dissections requiring stent reconstruction with multiple tandem stents (≥ 3 stents) and presenting with acute (<12 hours) ischemic stroke symptoms (NIHSS score, ≥ 4). Carotid stent reconstruction was successful in all patients with no residual stenosis or flow limitation. Nine patients (60%) harbored intracranial occlusions, and 6 patients (40%) required intra-arterial thrombolysis/thrombectomy, achieving 100% TICI 2b–3 reperfusion. They conclude that emergent stent reconstruction of long-segment and flow-limiting carotid dissections in acute ischemic stroke intervention is safe and effective, with favorable clinical outcomes.
- White Matter Injury and General Movements in High-Risk Preterm Infants
Cerebral palsy has been predicted by analysis of spontaneous movements in the infant termed “General Movement Assessment.” The authors evaluated the utility of General Movement Assessment in predicting adverse cognitive, language, and motor outcomes in very preterm infants and attempted to identify brain imaging markers associated with both adverse outcomes and aberrant general movements in 47 preterm infants using MRI volumetric analysis and DTI. Nine infants had aberrant general movements and were more likely to have adverse neurodevelopmental outcomes, compared with infants with normal movements. In infants with aberrant movements, Tract-Based Spatial Statistics analysis identified significantly lower fractional anisotropy in widespread WM tracts. They conclude that aberrant general movements at 10–15 weeks' postterm are associated with adverse neurodevelopmental outcomes and specific white matter microstructure abnormalities for cognitive, language, and motor delays.
- Limited Dorsal Myeloschisis and Congenital Dermal Sinus: Comparison of Clinical and MR Imaging Features
These investigators retrospectively reviewed the clinical and MR imaging findings of 12 patients with limited dorsal myeloschisis and 10 patients with congenital dermal sinus. A crater covered with pale epithelium was the most common skin lesion in limited dorsal myeloschisis (83%). Infectious complications were common in congenital dermal sinus (60%), but not found in limited dorsal myeloschisis. They show that limited dorsal myeloschisis has distinct MR imaging features including a visible intrathecal tract with dorsal tenting of the cord at the tract-cord union.
