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Background: Owing to their peculiar location, cavernous sinuses communicate with numerous head and neck structures via fissures and foramen which provide an easy access for pathologies to traverse to and from the cavernous sinuses to these vital structures. On routine brain imaging, diseases involving the cavernous sinuses can be easily missed if we are not vigilant to examine cavernous sinuses using dedicated thin sections of sellar and parasellar region. The various pathologic conditions involving cavernous sinuses either primarily or secondarily include neoplasms, vascular conditions, cystic/fat-containing lesions and infective/inflammatory conditions. Due to considerable overlap in clinical symptoms of numerous diseases affecting cavernous sinuses, timely and effective imaging evaluation of cavernous sinuses using multimodality approach with dedicated imaging sequences can help in formulating a clinically relevant differential diagnosis and alter patient management. Thin T1- and T2-weighted axial and coronal images with appropriately timed MR angiography and venography should be performed for diagnosis of cavernous sinus pathologies and delineation of pathologies arising from closely placed neurovascular structures in this region of middle cranial fossa. In this review article, we aim to discuss how to best image the cavernous sinuses for detection of cavernous sinus pathologies and imaging appearance of various pathologies involving cavernous sinuses. Conclusion: Cavernous sinuses form an important pathway for spread of numerous pathologies to and from the intracranial compartment to nearby vital structures. A variety of conditions can affect these small paired venous structures including benign and malignant neoplasms, vascular lesions, and infective/inflammatory pathologies. It is therefore important that besides routine brain imaging, dedicated thin axial and coronal images along with contrast-enhanced imaging should be performed for diagnosis of cavernous sinus pathologies. [ABSTRACT FROM AUTHOR]

Background: Wilson's disease is an inherited disease characterized by impaired copper metabolism that causes damage to many organs, including the brain. Patients having neurological involvement usually present with varied neuropsychiatric symptoms. Magnetic resonance imaging (MRI) Brain plays an indispensable role in identifying the structural involvement in these patients, aiding in early accurate diagnosis and timely management. Typically, basal ganglia, thalami and brainstem are involved, with bright claustrum sign, face of giant panda sign and miniature panda signs on MRI. Conclusions: Having knowledge about the commonly encountered and known MRI brain findings in Wilson's disease are essential in aiding accurate diagnosis and initiating early management. However, identifying the Atypical MRI brain characteristics is all the more imperative and should be considered in patients with prolonged or severe disease or in patients with rapid clinical progression and in patients showing poor response to treatment. [ABSTRACT FROM AUTHOR]

Abstract Background Owing to their peculiar location, cavernous sinuses communicate with numerous head and neck structures via fissures and foramen which provide an easy access for pathologies to traverse to and from the cavernous sinuses to these vital structures. On routine brain imaging, diseases involving the cavernous sinuses can be easily missed if we are not vigilant to examine cavernous sinuses using dedicated thin sections of sellar and parasellar region. Main body of the abstract The various pathologic conditions involving cavernous sinuses either primarily or secondarily include neoplasms, vascular conditions, cystic/fat-containing lesions and infective/inflammatory conditions. Due to considerable overlap in clinical symptoms of numerous diseases affecting cavernous sinuses, timely and effective imaging evaluation of cavernous sinuses using multimodality approach with dedicated imaging sequences can help in formulating a clinically relevant differential diagnosis and alter patient management. Thin T1- and T2-weighted axial and coronal images with appropriately timed MR angiography and venography should be performed for diagnosis of cavernous sinus pathologies and delineation of pathologies arising from closely placed neurovascular structures in this region of middle cranial fossa. In this review article, we aim to discuss how to best image the cavernous sinuses for detection of cavernous sinus pathologies and imaging appearance of various pathologies involving cavernous sinuses. Conclusion Cavernous sinuses form an important pathway for spread of numerous pathologies to and from the intracranial compartment to nearby vital structures. A variety of conditions can affect these small paired venous structures including benign and malignant neoplasms, vascular lesions, and infective/inflammatory pathologies. It is therefore important that besides routine brain imaging, dedicated thin axial and coronal images along with contrast-enhanced imaging should be performed for diagnosis of cavernous sinus pathologies.

Abstract Background Wilson’s disease is an inherited disease characterized by impaired copper metabolism that causes damage to many organs, including the brain. Patients having neurological involvement usually present with varied neuropsychiatric symptoms. Magnetic resonance imaging (MRI) Brain plays an indispensable role in identifying the structural involvement in these patients, aiding in early accurate diagnosis and timely management. Typically, basal ganglia, thalami and brainstem are involved, with bright claustrum sign, face of giant panda sign and miniature panda signs on MRI. Conclusions Having knowledge about the commonly encountered and known MRI brain findings in Wilson’s disease are essential in aiding accurate diagnosis and initiating early management. However, identifying the Atypical MRI brain characteristics is all the more imperative and should be considered in patients with prolonged or severe disease or in patients with rapid clinical progression and in patients showing poor response to treatment.

Meningiomas commonly manifest as granulations, dense clusters exhibiting hyperintense signals on the meningeal layers and close to cranial nerves. Detailed and isotropic imaging are key in the diagnostic evaluation. Nevertheless, standard MRI sequences have been inadequate in capturing these granulations, incorporating the T2 3D CISS axial sequence for improved visualization. Our case study aims to meticulously evaluate the diagnostic imaging strategies used for meningioma cases, explicitly focusing on cranial nerve imaging. The MRI protocol encompassed axial, coronal, and sagittal T2_TSE and DWI sequences and post-contrast T1-weighted imaging. A detailed calibration of the 3D CISS sequence parameters was performed to enhance the imaging of cranial nerves affected by the suspected meningioma. Our findings highlight the necessity of a meticulous MRI protocol, which includes precise imaging sequences, to evaluate meningiomas effectively, particularly for assessing the potential involvement of the cranial nerves.

Abstract Background The incidence estimates for intracranial subdural empyema are 0.1 per 100,000 individuals, making it a rare clinical condition. It is a highly morbid and fatal illness that is most commonly the result of a primary infection somewhere else. Case presentation The authors present a young male patient 15 years presented with 1 week history of headache, fever, confusion and seizure attack with initial negative CT head and nearly negative CSF analysis. With few days he developed left sided weakness. MRI brain showed right temporoparietal subdural fluid collection with midline shift. Urgent neurosurgical evacuation was made and revealed subdural empyema. The boy received combination therapy of vancomycin, ceftriaxone, and metronidazole. The culture of the pus was negative but 16S rRNA gene sequencing (bacterial) revealed streptococcus intermedius. He made a good recovery with no recollection or neurological deficit on follow up. Conclusion This case highlights the possibility of occurrence of this rare infection in otherwise healthy individuals without obvious precipitating factor. It also indicates the superiority of MRI brain over CT head in detection of subdural collection. The rapid diagnosis and intervention improve the outcome of the patient.

Background: The incidence estimates for intracranial subdural empyema are 0.1 per 100,000 individuals, making it a rare clinical condition. It is a highly morbid and fatal illness that is most commonly the result of a primary infection somewhere else. Case presentation: The authors present a young male patient 15 years presented with 1 week history of headache, fever, confusion and seizure attack with initial negative CT head and nearly negative CSF analysis. With few days he developed left sided weakness. MRI brain showed right temporoparietal subdural fluid collection with midline shift. Urgent neurosurgical evacuation was made and revealed subdural empyema. The boy received combination therapy of vancomycin, ceftriaxone, and metronidazole. The culture of the pus was negative but 16S rRNA gene sequencing (bacterial) revealed streptococcus intermedius. He made a good recovery with no recollection or neurological deficit on follow up. Conclusion: This case highlights the possibility of occurrence of this rare infection in otherwise healthy individuals without obvious precipitating factor. It also indicates the superiority of MRI brain over CT head in detection of subdural collection. The rapid diagnosis and intervention improve the outcome of the patient. [ABSTRACT FROM AUTHOR]

Introduction: Infantile tremor syndrome (ITS) is characterized by gradual onset of mental and psychomotor changes, pigmentary disturbances in hairs and skin, pallor, tremors and neuroregression in malnourished children aged between 5 months and 3 years. It is a well-known entity, but the exact etiopathogenesis is still not known. We aimed to determine clinical, haematological and neuroimaging profile in patients admitted with infantile tremor syndrome. Material & Methods: This prospective cross-sectional study was conducted in Department of Pediatrics, IMCHRC, Indore on 18 children in age group of 6 months to 5 years admitted with the diagnosis of ITS. Clinical, haematological and radiological profile parameters were analysed. Statistical analysis was done. Results: Mean age was 12.21±3.69 months. M:F ratio was 1.25:1. 14(77.7%) had height less than -3SD & 17(94.4%) has weight <-3SD. 13(72.2%) of children belonged to lower socioeconomic status and 15(83.3%) were exclusively breastfed. SAM was reported in 2(11.1%) children. 17(77.7%) reported Vit B12 deficiency. Progressive paleness [16(88.9%)], developmental delay [11(61.1%)] and developmental regression [10(55.5%)] were the most common complaints. 66.7% had tremors at presentation. In MRI findings, the major findings were poor myelination with thinning of corpus callosum [3(16.7%)] and uniform thinning of corpus callosum with subtle hypomyelination in bilateral frontal lobes [2(11.1%)]. In majority of children [6(33.33%)] tremor disappeared in 11-15 days after starting treatment. Conclusion: ITS should be considered as a differential diagnosis in an infant on exclusive breast feeding with vegetarian mother and poor weaning practices presenting with neuroregression, tremor and malnutrition with skin changes. [ABSTRACT FROM AUTHOR]

Background. Stroke is defined as a sudden onset of a neurological deficit attributed to a focal vascular cause. It is one of the leading causes of mortality and morbidity all over the world. The present study aimed to estimate the NIHS score and volume of stroke in predicting 30-day mortality in acute ischemic stroke patients. Material and methods. The present study was a prospective cross-sectional study conducted in 100 patients above 18 years old, of either gender, with symptoms of stroke for less than 24 hours, diagnosis of acute ischemic stroke based on history, physical examination, CT scan and/or diffusion weighted MRI scan performed during the first 24 hours. Results. In the present study, the mean age was 57.4±13.36 years. The volume of stroke on 1st day was 40. 75 ± 38.51, and on 30th day it was reduced to 31.94±33.20 which was statistically significant. NIHSS (National Institutes of Health Stroke Scale) score on day 1 was 9.70±5.22, and on day 30 it was 7.77±5.25, with a statistically significant difference (p=0.000). At the end of the 30 days, 10% mortality was observed. NIHSS score and volume of stroke were significantly associated with the 30-day outcome. Conclusion. In conclusion, integrating NIHSS scoring and stroke volume assessment into routine clinical practice enhances predictive accuracy for 30-day mortality in acute ischemic stroke patients. These findings advocate for early intervention strategies aimed at reducing stroke volume and improving neurological outcomes. Further research is recommended to validate these findings across diverse populations and settings, potentially refining acute stroke management protocol. [ABSTRACT FROM AUTHOR]

The proposed fuzzy composition-based filtering method aims to remove a presence of fractal Brownian noise in the MR brain images. The fractional Brownian motion (FBM) noise is a continuous time Gaussian processed noise and its very difficult to identify the positions and range of noise density level, due to a smoothed noise. The projected fuzzy scheme encloses an equivalent fuzzy interference scheme, a fuzzy average procedure and a fuzzy composition procedure. The noise subtraction scheme has been confirmed to be the finest while the depiction is tainted by means of fractional Brownian motion. With an average o/p Peak Signal to Noise Ratio(PSNR) of 37.22 and an average noisy image PSNR of 20.28, the average PSNR rate has improved by 16.94. In addition, the average mean square error (MSE) rate has decreased from 609.48 to 12.33 percent. An experimental result confirms that the fuzzy filtering achieves an outstanding eminence of reinstated images in terms of PSNR and MSE without the assistance of noiseless depiction. [ABSTRACT FROM AUTHOR]

الملخص: أهداف البحث: مرض باركنسون والشلل العصبي العلوي التدرجي هما حالتان عصبية تتدهور وتتشابه في السمات السريرية والتصوير. هذا ينتج عنه صعوبة في تشخيص الشلل العصبي العلوي التدرجي من مرض باركنسون. لذا، تهدف الدراسة إلى التحقق من القيمة الأمثل للقياس الخطي للرنين المغناطيسي ومؤشر باركنسون الذي يمكن أن يميز بين الشلل العصبي العلوي التدرجي ومرض باركنسون. طرق البحث: تضمنت الدراسة الاستعادية مجموعة من 84 مريضا، كان 27 مريضا من كل من الشلل العصبي العلوي التدرجي، ومرض باركنسون، والمراقبين الطبيعيين الذين خضعوا لفحص الرنين المغناطيسي للدماغ. تم قياس منطقة الجسم الثنائي، ومنطقة الدماغ الوسطى، ومنطقة الجسر، وعرض دماغ العصب القحفي الأوسط وعرض الدماغ القحفي العلوي على صورة الرنين المغناطيسي للدماغ. تم حساب نسبة منطقة الجسر إلى الدماغ الوسطى، ونسبة عرض دماغ العصب القحفي الأوسط إلى عرض الدماغ القحفي العلوي ومؤشر باركنسون على الرنين المغناطيسي. النتائج: تم استخدام تحليل منحنى الخصائص التشغيلية للمستقبل لتحديد القيمة التشخيصية لكل علامة حيوية. أظهر مؤشر باركنسون على الرنين المغناطيسي حساسية تبلغ 70.4 ٪، وتحديدية تبلغ 88.9 ٪، ودقة تشخيص تبلغ 79.6 ٪ مع قيمة قطع مثلى تبلغ 24.3 للتمييز بين الشلل العصبي العلوي التدرجي ومرض باركنسون. أظهرت نسبة منطقة الجسر إلى الدماغ الوسطى حساسية تبلغ 74.1 ٪، وتحديدية تبلغ 77.8 ٪، ودقة تشخيص تبلغ 75.9 ٪ مع قيمة قطع مثلى تبلغ 24.3 للتمييز بين الشلل العصبي العلوي التدرجي ومرض باركنسون. أظهرت نسبة عرض دماغ العصب القحفي الأوسط إلى عرض الدماغ القحفي العلوي حساسية تبلغ 66.7 ٪، وتحديدية تبلغ 77.8 ٪، ودقة تبلغ 72.2 ٪ مع قيمة قطع مثلى تبلغ 4.65 للتمييز بين الشلل العصبي العلوي التدرجي ومرض باركنسون. الاستنتاجات: كشفت الدراسة أن مؤشر باركنسون على الرنين المغناطيسي ونسبة منطقة الجسر إلى الدماغ الوسطى هما علامات دقيقة للتمييز بين الشلل العصبي العلوي التدرجي ومرض باركنسون وأيضا يمكن أن تساعد القيم الأمثل المشتقة من دراستنا في التشخيص المبكر لمرض باركنسون. Abstract: Objectives: Parkinson's disease (PD) and progressive supranuclear palsy (PSP) are neurodegenerative conditions that have overlapping clinical and imaging features, thus making it difficult to distinguish and diagnose PSP from PD. Therefore, in this study, we aimed to investigate the optimal value of magnetic resonance planimetry and the parkinsonism index to differentiate between PSP and PD. Methods: In this retrospective study, we recruited a total of 84 patients (27 patients with PSP, 27 patients with PD and 27 normal controls) who underwent MRI brain examinations. For each subject, we calculated the corpus callosum area, midbrain area, pons area, middle cerebellar peduncle (MCP) width and superior cerebellar peduncle (SCP) width on MRI brain images. We also calculated the pons to midbrain area (P/M) ratio, MCP/SCP ratio and magnetic resonance parkinsonism index (MRPI). Results: Receiver operating characteristic curve (ROC) analysis was used to identify the diagnostic value of each biomarker. MRPI had a sensitivity of 70.4%, a specificity of 88.9%, and a diagnostic accuracy of 79.6% with an optimum cut off of 24.3 for differentiating PSP from PD. P/M ratio had a sensitivity of 74.1%, a specificity of 77.8%, and a diagnostic accuracy of 75.9% with an optimal cutoff of 24.3 for differentiating PSP from PD. The MCP/SCP ratio had a sensitivity of 66.7%, a specificity of 77.8%, and an accuracy of 72.2% with an optimal cut off of 4.65 for differentiating PSP from PD. Conclusions: The study revealed that MRPI and P/M ratio are accurate markers for differentiating PSP from PD. The optimal cut-off values derived from our study can help in the early diagnosis of PD.

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Hypoxic ischaemic encephalopathy (HIE) is associated with oxidative stress. A potential marker of oxidative damage is carboxyhaemoglobin (COHb) which is the product of the reaction between carbon monoxide and haemoglobin and is routinely assessed on blood gas analysis. Our objective was to test the hypothesis that higher COHb levels would be associated with worse outcomes in infants treated for HIE. A retrospective, observational study was performed of all infants who received whole body hypothermia for HIE at a tertiary neonatal intensive care unit between January 2018 and August 2021. For each participating infant, the highest COHb level per day was recorded for days one, three and five after birth. During the study period, 67 infants with a median (IQR) gestational age of 40 (38–41) weeks underwent therapeutic hypothermia for HIE. The median (IQR) COHb level on day three was higher in infants without electroencephalographic seizures (1.4 [1.1–1.4] %) compared with infants with seizures (1.1 [0.9–1.3] %, p=0.024). The median (IQR) COHb on day five was higher in infants without MRI brain abnormalities (1.4 [1.2–1.7] %) compared with infants with MRI abnormalities (1.2 [1.0–1.4] %, p=0.032). The COHb level was not significantly different between the nine infants who died compared to the infants who survived. COHb levels were higher in infants with HIE without seizures and in those with normal MRI brain examinations. We suggest that carbon monoxide has a potential protective role in HIE. [ABSTRACT FROM AUTHOR]

Abstract Background Differentiation between the grades of brain gliomas is a crucial step in the management of patients. The gold standard technique for grading is biopsy but MR imaging may play a more substantial role as a non-invasive method by using promising molecular sequences. Our purpose was to assess the added value of the relative amide proton transfer signal [rAPT] to advanced multiparametric MRI protocol. Methods We enrolled a pathologically confirmed 102 patients with low-grade glioma [n = 38] and high-grade glioma [n = 64] who underwent advanced multiparametric MRI protocol on the same scanner. The protocol included anatomic, diffusion, MRS, and perfusion sequences. The newly added sequence was Amide proton transfer. The rAPT values of all lesions were investigated by two neuroradiologists to assess the inter-rater agreement of using interclass correlation coefficient [ICC]. HGGs demonstrated significantly higher mean values of relative cerebral blood volume (rCBV), choline to creatine ratio (Cho/cr), and rAPT with lower Apparent diffusion coefficient (ADC) values compared to LGGs. ROC analyses revealed medium to high diagnostic performance with an AUC of 0.941 for rAPT, 0.907 for mean ADC, and 0.906 for rCBV. Discriminant function analysis of two models, the first one included mean ADC, rCBV, and Cho/Cr, while in the second Model, we added rAPT to them. Model two demonstrated higher accuracy and a significant difference in the AUC after adding the rAPT. The inter-rater agreement was reasonable (ICC 0.61). Conclusions rAPT adds significant value to multiparametric MRI for distinguishing LGG from HGG.

High-altitude cerebral edema is a rare type of acute mountain illness characterized by consciousness disruption and truncal ataxia. Here we discuss a 40-year-old nondiabetic, nonsmoker male who went on a tour to Nanga Parbat. On returning home, the patient developed symptoms of headache, nausea, and vomiting. His symptoms worsened with time and he developed lower limb weakness and shortness of breath. Later, he underwent a computerized tomography chest scan. On the basis of CT scan findings, the doctors decided that the patient was suffering from COVID-19 Pneumonia despite having negative COVID-19 PCR tests multiple times. Later, the patient presented to our hospital with similar complaints. MRI of the brain revealed T2/fluid-attenuated inversion recovery hyperintense and T1 hypointense signals in the bilateral semioval centrum, posterior periventricular white matter, and corpus callosum genu, body, and splenium. These abnormal signals were discovered to be more evident in the corpus callosum's splenium. Moreover, susceptibility-weighted imaging revealed micro hemorrhages in the corpus callosum. This verified the diagnosis that the patient is suffering from high-altitude cerebral edema. Within 5 days, his symptoms resolved and he was discharged with full recovery.

Background: Differentiation between the grades of brain gliomas is a crucial step in the management of patients. The gold standard technique for grading is biopsy but MR imaging may play a more substantial role as a non-invasive method by using promising molecular sequences. Our purpose was to assess the added value of the relative amide proton transfer signal [rAPT] to advanced multiparametric MRI protocol. Methods: We enrolled a pathologically confirmed 102 patients with low-grade glioma [n = 38] and high-grade glioma [n = 64] who underwent advanced multiparametric MRI protocol on the same scanner. The protocol included anatomic, diffusion, MRS, and perfusion sequences. The newly added sequence was Amide proton transfer. The rAPT values of all lesions were investigated by two neuroradiologists to assess the inter-rater agreement of using interclass correlation coefficient [ICC]. HGGs demonstrated significantly higher mean values of relative cerebral blood volume (rCBV), choline to creatine ratio (Cho/cr), and rAPT with lower Apparent diffusion coefficient (ADC) values compared to LGGs. ROC analyses revealed medium to high diagnostic performance with an AUC of 0.941 for rAPT, 0.907 for mean ADC, and 0.906 for rCBV. Discriminant function analysis of two models, the first one included mean ADC, rCBV, and Cho/Cr, while in the second Model, we added rAPT to them. Model two demonstrated higher accuracy and a significant difference in the AUC after adding the rAPT. The inter-rater agreement was reasonable (ICC 0.61). Conclusions: rAPT adds significant value to multiparametric MRI for distinguishing LGG from HGG. [ABSTRACT FROM AUTHOR]

Abstract Background Epilepsy is the third chronic brain illness worldwide. About a third of the epileptic patients will be drug resistant. Early identification of these patients is critical for appropriate treatment selection and prevention of the devastating consequences of recurrent seizures. The objective of this study aims to detect clinical, electrophysiological, and radiological predictors for drug-resistant epilepsy patients. Results One hundred fifty-five patients were included in this study, divided into a well-controlled epilepsy group (103 patients) and a drug-resistant group (52 patients). Both groups were compared regarding clinical, electrophysiological, and neuro-radiological data. Younger age at onset, history of delayed milestones, history of perinatal insult (especially hypoxia), mental retardation, neurological deficits, depression, status epilepticus (SE), complex febrile seizures, focal seizure to bilateral tonic–clonic convulsion as well as multiple seizures and high seizure frequency (daily) at onset, poor response to first anti-seizure drug (ASD), structural and metabolic etiology, abnormal brain imaging, and slow background and multifocal epileptiform discharges in EEG were significant risk factors for the development of drug-resistant epilepsy. Conclusion MRI abnormalities are the most significant predictor for drug-resistant epilepsy. Drug-resistant epilepsy is associated with clinical, electrophysiological, and radiological risk factors that can be used to diagnose drug-resistant patients early and choose the best treatment option and time.

Abstract Background Cerebral small vessel disease (SVD) is associated with acute events such as lacunar and hemorrhagic strokes, or chronic events such as cognitive deficit in the form of subcortical dementia, mood deficit in the form of late onset depression, sphincteric affection, and gait apraxia. Under conditions of moderate blood flow deficit, the inability of sclerotic vessels to dilate due to impairment of the cerebral autoregulation, renders the periventricular white matter seriously ischemic. Therefore, it is important to detect the implications of cerebral large artery disease on the severity of SVD, and the ability of transcranial duplex (TCD) to evaluate it in people at risk. Methods Fifty lacunar stroke patients were recruited, and evaluated using MRI brain to assess SVD score, carotid duplex and TCD to assess extracranial and intracranial stenoses, respectively. Results Both intracranial and extracranial stenoses showed significant relation to the severity of cerebral SVD. Moreover, there were significant relation between intracranial stenosis and presence of lacuna and EPVS. Conclusion Cerebral large artery disease contributes to the pathogenesis and severity of cerebral SVD. Therefore, TCD may be a useful tool for the prediction of occurrence of cerebral SVD in high-risk individuals, especially hypertensives.

Abstract Background The recent pandemic of COVID‐19 has thrown the world into chaos due to its high rate of transmissions. Recently viewed neurological manifestations among hospitalized Egyptian patients with COVID‐19 in quarantine centres. Ataxia, disturbed consciousness and convulsions should be further evaluated by MRI and MRS for CNS involvement by SARS‐CoV‐2. How COVID-19 targeting the CNS is still under study, as it is difficult to predict which diagnostic neurological tests will be used to identify high-risk COVID19 patients. MR spectroscopy represents a non-invasive in vivo diagnostic technique for evaluation of metabolic profile of the brain and can reveal important information about the underlying pathologies. Multiple recent reports in the medical literature had confirmed the neurological complications in COVID-19 infection, though few studies has reported the MR spectroscopic findings in these patients. This cross-sectional study aimed to use MRI and MR spectroscopic findings for evaluation of the neurological manifestation of Egyptian COVID‐19 patients. Results Ninety-one male and twenty-seven female met the inclusion criteria, with a mean age of 52 years ± 10 (SD) (age range; 12–78 years). The commonest neurological manifestations were disturbed conscious level (82.2%). The most common MRI findings were acute ischemic insult with/without haemorrhagic areas (42.3%), demyelinating patches of altered signal intensity (31.3%). Sixty cases who had haemorrhagic areas were excluded to perform MRS due to contamination of the spectra by blood component. However, the remaining 67 patients had NAA reduction, choline elevation, glutamate/glutamine and lactate elevation in short TE35, with mean of NAA/Cr ratio = 1.04 ± 0.14, Choline/Cr = 0.49 ± 0.04 and Glx/Cr = 1.56 ± 0.22. Conclusions During the current pandemic of COVID-19, radiologists should be aware of wide spectrum of MRI and MRS findings of COVID-19-related CNS involvement.

Background: Epilepsy is the third chronic brain illness worldwide. About a third of the epileptic patients will be drug resistant. Early identification of these patients is critical for appropriate treatment selection and prevention of the devastating consequences of recurrent seizures. The objective of this study aims to detect clinical, electrophysiological, and radiological predictors for drug-resistant epilepsy patients. Results: One hundred fifty-five patients were included in this study, divided into a well-controlled epilepsy group (103 patients) and a drug-resistant group (52 patients). Both groups were compared regarding clinical, electrophysiological, and neuro-radiological data. Younger age at onset, history of delayed milestones, history of perinatal insult (especially hypoxia), mental retardation, neurological deficits, depression, status epilepticus (SE), complex febrile seizures, focal seizure to bilateral tonic–clonic convulsion as well as multiple seizures and high seizure frequency (daily) at onset, poor response to first anti-seizure drug (ASD), structural and metabolic etiology, abnormal brain imaging, and slow background and multifocal epileptiform discharges in EEG were significant risk factors for the development of drug-resistant epilepsy. Conclusion: MRI abnormalities are the most significant predictor for drug-resistant epilepsy. Drug-resistant epilepsy is associated with clinical, electrophysiological, and radiological risk factors that can be used to diagnose drug-resistant patients early and choose the best treatment option and time. [ABSTRACT FROM AUTHOR]

Objective: The 2-year incidence of brain metastases (BrMs) in stage III non-small lung cell cancer (NSCLC) has been estimated to be around 30%. However, recent clinical trials have demonstrated considerably lower BrMs rates in this patient population. In this study, we aimed to review the real-world incidence, surveillance, and treatment patterns of BrMs in stage III NSCLC. Materials and methods: Using a retrospective single-center study design, we identified patients with stage III NSCLC who received radiation with curative intent over a 10-year period. Outcome variables included BrMs incidence, overall survival (OS), and survival from date of BrMs. Additionally, we assessed patterns of BrMs surveillance in stage III NSCLC and treatment. Results: We identified a total of 279 stage III NSCLC patients, of which 160 with adequate records were included in the final analyses [adenocarcinoma (n = 96), squamous cell carcinoma (n = 53), other histology subtype (n = 11)]. The median OS for the entire cohort was 41 months (95% CI, 28-53), while the median time from BrMs to death was 19 months (95% CI, 9-21). Twenty-three patients (14.4%) received planned surveillance brain MRIs at 6, 12, and 24 months after completion of treatment. The remaining 137 patients (85.6%) received brain MRIs at systemic recurrence (restaging) or when neurologically symptomatic. A total of 37 patients (23%) developed BrMs,with a 2-year cumulative BrMs incidence of 17% (95% CI, 11- 23). A higher incidence of BrMs was identified in patients with adenocarcinoma relative to those with squamous cell carcinoma (p < 0.01). Similarly, a higher 2-year BrMs incidence was observed in patients who received planned surveillance brain MRI relative to those who did not, although statistical significancewas not reached. Stereotactic radiosurgery (SRS) treated 29 of BrMs patients (78.4%) and was preferred over WBRT, which treated only 3 patients (8.1%).Conclusions: At our center, BrMs incidence in stage III NSCLC patients was lower than historically reported but notably higher than the incidence described in recent clinical trials. Routine BrMs surveillance potentially allows earlier detection of asymptomatic BrMs. However, asymptomatic BrMs were mostly detected on restaging MRI at the time of recurrence. [ABSTRACT FROM AUTHOR]

kull stripping is regarded as an important pre-processing step by many neuroimaging processing applications. An appropriate skull stripping is crucial because of the complex anatomical makeup of the brain and variations in brain MRI intensity. The removal of the skull region for clinical analysis in brain segmentation tasks is essentially the process of "skull stripping," and its accuracy and effectiveness are very important for diagnostic purposes. It is thought to be a difficult task because it calls for more precise and thorough methods for separating the different regions of the brain and the skull. Consequently, a technique is suggested for skull stripping by improving the contrast of the brain image using Adaptive gamma correction (AGC), which sets its settings dynamically based on the properties of the input image. In addition, the largest connected components, morphological image processing technique, and image multiplications are used in the proposed skull stripping method. The Br35H::Brain Tumor Detection 2020 dataset and Brain MRI Images for Brain Tumor Detection dataset have been used for the experimentation. The results of the experiments show that the proposed image enhancement and skull removal techniques work effectively with an accuracy rate of 96%. [ABSTRACT FROM AUTHOR]

Currently, ASL is widely used as an additional breakthrough sequence in MRI due to acquiring reliable results. The case report aims to prove the efficacy and effectiveness of a quantitative method of ASL sequence through the calculation of the cerebral blood flow (CBF) on CBF maps in different cases. ASL sequence has been done on four patients with different cases. Then, the authors put 2 regions of interest (ROI) for measurement in normal and different regions on CBF maps and then calculated the average value result from CBF maps. ASL has been proven as a reliable and breakthrough sequence in MRI for detecting brain disease with a non-invasive method through the calculation of CBF value. ASL should be used as an additional protocol in brain examinations because it allows radiologists to assess the significance of CBF values using a quantitative method that is more reliable and non-invasive. [ABSTRACT FROM AUTHOR]

ObjectiveThe 2-year incidence of brain metastases (BrMs) in stage III non-small lung cell cancer (NSCLC) has been estimated to be around 30%. However, recent clinical trials have demonstrated considerably lower BrMs rates in this patient population. In this study, we aimed to review the real-world incidence, surveillance, and treatment patterns of BrMs in stage III NSCLC.Materials and methodsUsing a retrospective single-center study design, we identified patients with stage III NSCLC who received radiation with curative intent over a 10-year period. Outcome variables included BrMs incidence, overall survival (OS), and survival from date of BrMs. Additionally, we assessed patterns of BrMs surveillance in stage III NSCLC and treatment.ResultsWe identified a total of 279 stage III NSCLC patients, of which 160 with adequate records were included in the final analyses [adenocarcinoma (n = 96), squamous cell carcinoma (n = 53), other histology subtype (n = 11)]. The median OS for the entire cohort was 41 months (95% CI, 28-53), while the median time from BrMs to death was 19 months (95% CI, 9-21). Twenty-three patients (14.4%) received planned surveillance brain MRIs at 6, 12, and 24 months after completion of treatment. The remaining 137 patients (85.6%) received brain MRIs at systemic recurrence (restaging) or when neurologically symptomatic. A total of 37 patients (23%) developed BrMs, with a 2-year cumulative BrMs incidence of 17% (95% CI, 11-23). A higher incidence of BrMs was identified in patients with adenocarcinoma relative to those with squamous cell carcinoma (p < 0.01). Similarly, a higher 2-year BrMs incidence was observed in patients who received planned surveillance brain MRI relative to those who did not, although statistical significance was not reached. Stereotactic radiosurgery (SRS) treated 29 of BrMs patients (78.4%) and was preferred over WBRT, which treated only 3 patients (8.1%).ConclusionsAt our center, BrMs incidence in stage III NSCLC patients was lower than historically reported but notably higher than the incidence described in recent clinical trials. Routine BrMs surveillance potentially allows earlier detection of asymptomatic BrMs. However, asymptomatic BrMs were mostly detected on restaging MRI at the time of recurrence.

Background: Cerebral small vessel disease (SVD) is associated with acute events such as lacunar and hemorrhagic strokes, or chronic events such as cognitive deficit in the form of subcortical dementia, mood deficit in the form of late onset depression, sphincteric affection, and gait apraxia. Under conditions of moderate blood flow deficit, the inability of sclerotic vessels to dilate due to impairment of the cerebral autoregulation, renders the periventricular white matter seriously ischemic. Therefore, it is important to detect the implications of cerebral large artery disease on the severity of SVD, and the ability of transcranial duplex (TCD) to evaluate it in people at risk. Methods: Fifty lacunar stroke patients were recruited, and evaluated using MRI brain to assess SVD score, carotid duplex and TCD to assess extracranial and intracranial stenoses, respectively. Results: Both intracranial and extracranial stenoses showed significant relation to the severity of cerebral SVD. Moreover, there were significant relation between intracranial stenosis and presence of lacuna and EPVS. Conclusion: Cerebral large artery disease contributes to the pathogenesis and severity of cerebral SVD. Therefore, TCD may be a useful tool for the prediction of occurrence of cerebral SVD in high-risk individuals, especially hypertensives. [ABSTRACT FROM AUTHOR]

This report aims to describe a characteristic neuroimaging of Listeria monocytogenes brain abscess in predisposed patients. A 56-year-old man presented with fever and headache for 3 weeks. Cerebrospinal fluid (CSF) revealed pleocytosis with lymphocytosis, high protein, and low glucose. Both hemoculture and CSF culture yielded L monocytogenes. Another case is a 23-year-old woman with systemic lupus erythematosus, who presented with fever, headache and left hemiparesis. CSF showed pleocytosis with polymorphonuclear cells predominance and low glucose. Hemoculture positive for L monocytogenes. Their MRI brain revealed conglomerate ring and tract-like enhancement lesions at the right parietotemporal lobe. The patients were diagnosed with L monocytogenes brain abscess. They received a high dose of ceftriaxone and ampicillin for 6 weeks. The clinical and MRI at the end of treatment was a substantial improvement. Our information can help the physician concern about this pathogen in patients who presented with brain abscess and had these MRI findings.

Abstract Background This study aims to compare functional outcome for Computed tomography (CT)-based versus Magnetic resonance imaging (MRI)-based evaluation in acute ischemic stroke patients prior to Mechanical thrombectomy (MT) in less than 6-h window period in anterior circulation stroke. Participants were patients admitted from September 2, 2018 to September 2, 2020 with an acute ischemic stroke who underwent mechanical thrombectomy treatment. Total duration of MRI stroke protocol and CT scan with Computed tomography angiography (CTA) was 12 min 57 s, and 9 min 23 s, respectively. Follow-up for periodic Modified Rankin Scale (MRS) was performed at 3 months. Results Number of patients included in the study were 152 with mean age of 54.6 (range 22–80) years with male predominance (n = 102). Mean GCS on admission was 12 (4–15) and 13(4–14) in CT and MRI group, respectively. National Institute of Health stroke scale (NIHSS) on admission was 17 (4–30) and 16(4–30) and at discharge was 7 (2–23) and 6(2–22) in CT-based group and MRI-based group, respectively. In the MRI group 65.5% had good outcome with mRS (0–2) at 3-month follow-up compared to 35.51% in CT group. Conclusion The current standard neuroimaging in acute ischemic stroke patients is CT and CTA brain. Using MRI over CT scan for acute ischemic stroke may improve clinical outcomes for the subgroup of patients who have an unclear diagnosis and who have higher risk of complications with MT. Even though MRI and MRA take longer period to acquire, patient’s clinical outcome was better in MRI group in comparison to CT group and was comparable to that of the five major endovascular trials.

Metronidazole is a common antibiotic agent for hepatic abscesses, which require both gram-negative and anaerobic coverage. Rarely, this antibiotic has been found to induce encephalopathy. Here, we describe a 65-year-old male who was treated with metronidazole for his hepatic abscess, who presented with syncope and questionable seizure and was found to have magnetic resonance imaging (MRI) brain findings consistent with metronidazole toxicity. Our patient demonstrated striking brain MRI findings which can be used to further understand the process behind this medication-induced toxicity. Hypotheses of this mechanism include swelling of axons secondary to increased water or vasospasm leading to reversible ischemia that is localized in the brain. In terms of MRI findings, brain lesions tend to populate bilaterally with focus at the dorsal pons, midbrain, cerebellar dentate nuclei (as with our patient), dorsal medulla, or splenium of corpus callosum. Additional research is warranted regarding this rare manifestation and timely removal of the offending agent is crucial for reversal of symptoms.

Background: The recent pandemic of COVID‐19 has thrown the world into chaos due to its high rate of transmissions. Recently viewed neurological manifestations among hospitalized Egyptian patients with COVID‐19 in quarantine centres. Ataxia, disturbed consciousness and convulsions should be further evaluated by MRI and MRS for CNS involvement by SARS‐CoV‐2. How COVID-19 targeting the CNS is still under study, as it is difficult to predict which diagnostic neurological tests will be used to identify high-risk COVID19 patients. MR spectroscopy represents a non-invasive in vivo diagnostic technique for evaluation of metabolic profile of the brain and can reveal important information about the underlying pathologies. Multiple recent reports in the medical literature had confirmed the neurological complications in COVID-19 infection, though few studies has reported the MR spectroscopic findings in these patients. This cross-sectional study aimed to use MRI and MR spectroscopic findings for evaluation of the neurological manifestation of Egyptian COVID‐19 patients. Results: Ninety-one male and twenty-seven female met the inclusion criteria, with a mean age of 52 years ± 10 (SD) (age range; 12–78 years). The commonest neurological manifestations were disturbed conscious level (82.2%). The most common MRI findings were acute ischemic insult with/without haemorrhagic areas (42.3%), demyelinating patches of altered signal intensity (31.3%). Sixty cases who had haemorrhagic areas were excluded to perform MRS due to contamination of the spectra by blood component. However, the remaining 67 patients had NAA reduction, choline elevation, glutamate/glutamine and lactate elevation in short TE35, with mean of NAA/Cr ratio = 1.04 ± 0.14, Choline/Cr = 0.49 ± 0.04 and Glx/Cr = 1.56 ± 0.22. Conclusions: During the current pandemic of COVID-19, radiologists should be aware of wide spectrum of MRI and MRS findings of COVID-19-related CNS involvement. [ABSTRACT FROM AUTHOR]

We report the case of a 62-year-old male who presented to the Emergency Department (ED) with altered mental status following a motor vehicle accident. He was transferred to the Intensive Care Unit (ICU) with worsening of his neurological status and subsequently diagnosed with Murray Valley encephalitis: a serious but rare condition caused by infection with Murray Valley encephalitis virus (MVEV). He continued to deteriorate despite treatment with antivirals, glucocorticoids, and therapeutic plasma exchange (TPE) in addition to supportive care and eventually succumbed to his illness. In this report, we review the clinical course, pathophysiology, diagnosis, and characteristic radiological features of Murray Valley encephalitis and highlight the challenges in treating this potentially devastating disease., Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Derrick et al.)

Alzheimer's disease (AD) is a slowly progressive degenerative neurological disease characterized by severe degeneration of cortical neurons. Detecting Alzheimer's is a difficult and time consuming task. Therefore, developing an automated analysis system that is fast, costs less, and is more reliable is essential to help clinicians in the early diagnosis. In this paper, we proposed a deep convolutional neural network (IRDNet) to classify Alzheimer's disease from normal controls (NC) using brain magnetic resonance (MR) images. The proposed IRDNet is based on residual network with dense block to obtain a higher performance over the original residual network and is constructed by using three parallel levels with receptive fields of different sizes to capture global and local features of the inputs. Our model is evaluated and trained on brain MRI images acquired from the Open Access Series of Imaging Studies database (OASIS). The experimental results reveal that our IRDNet achieved an average accuracy of 98.53% after training it for 3.127 seconds for two-class classification (AD vs. normal), which represents a promising classification performance. [ABSTRACT FROM AUTHOR]

Background: The term seizure is used to describe abnormal, uncontrolled paroxysmal electrical activity of brain, literature suggests that about 8 -10% of population may experience at least one episode of seizure. In adult patients with new onset seizures, neuroimaging studies like MRI brain are advised to find out the underlying cause, structural abnormality, and the likelihood of recurrence. For neuroimaging, CT scan and MRI both can be done but for detection of cerebral lesions, imaging with MRI is considered superior to CT scan. MRI becomes essential, because of its superior depiction of brain anatomy and tissue composition. Aims and Objectives: To Evaluate the MRI brain study in new onset seizure and to identify a lesion in MRI brain that can explain the seizure. Materials and methods: sixty-nine patients (age 18 and above with new onset seizures) were studied in the out-patient and in-patient department of medicine of a tertiary care centre of central India from 1st July 2019 to 30th June 2021. All patients fulfilling inclusion criteria were subjected to detailed clinical history, examination including neurological examination, and etiology and characteristics of seizure were co related with MRI brain findings. Results: The majority of patients were presented with focal seizures 38(55%)and with generalized seizure 31(45%). Seizures are more prevalent in age 18 to 40 years. The prevalence of seizures was higher in males (60%) than in females (40%). MRI brain revealed abnormal findings on 68.1% cases with new onset seizures. MRI revealed CVA in 17.3% cases (infarct in 13% and bleed in 4.3%), tuberculoma in 7.2% and neurocysticercosis in 5.8% cases, viral and tubercular meningitis in 4.3% cases each, Cortical Venous Thrombosis was noted in 8.7% cases, AV Malformations, Mesial temporal lobe sclerosis, Posterior reversible encephalopathy syndrome (PRES) and Dyke Davidoff Masson Syndrome were noted in 2.9% cases each. [ABSTRACT FROM AUTHOR]

Background: This study aims to compare functional outcome for Computed tomography (CT)-based versus Magnetic resonance imaging (MRI)-based evaluation in acute ischemic stroke patients prior to Mechanical thrombectomy (MT) in less than 6-h window period in anterior circulation stroke. Participants were patients admitted from September 2, 2018 to September 2, 2020 with an acute ischemic stroke who underwent mechanical thrombectomy treatment. Total duration of MRI stroke protocol and CT scan with Computed tomography angiography (CTA) was 12 min 57 s, and 9 min 23 s, respectively. Follow-up for periodic Modified Rankin Scale (MRS) was performed at 3 months. Results: Number of patients included in the study were 152 with mean age of 54.6 (range 22–80) years with male predominance (n = 102). Mean GCS on admission was 12 (4–15) and 13(4–14) in CT and MRI group, respectively. National Institute of Health stroke scale (NIHSS) on admission was 17 (4–30) and 16(4–30) and at discharge was 7 (2–23) and 6(2–22) in CT-based group and MRI-based group, respectively. In the MRI group 65.5% had good outcome with mRS (0–2) at 3-month follow-up compared to 35.51% in CT group. Conclusion: The current standard neuroimaging in acute ischemic stroke patients is CT and CTA brain. Using MRI over CT scan for acute ischemic stroke may improve clinical outcomes for the subgroup of patients who have an unclear diagnosis and who have higher risk of complications with MT. Even though MRI and MRA take longer period to acquire, patient's clinical outcome was better in MRI group in comparison to CT group and was comparable to that of the five major endovascular trials. [ABSTRACT FROM AUTHOR]

Abstract Background Focal epilepsy is the most common form of epilepsy in adults. Advances in brain imaging allowed better identification of different structural lesions underlying focal epilepsy. However, the response to antiepileptic drugs in lesional epilepsy is heterogeneous and difficult to anticipate. This study aimed to evaluate the response to antiepileptic drugs (AED) in patients with lesional epilepsy and to identify the predictors for poor seizure control. Methods One hundred and sixty-five patients with lesional epilepsy were included; the clinical diagnosis of epilepsy and seizure classification was based on the revised criteria of the International League Against Epilepsy (ILAE). Patients were subjected to full clinical assessment, MRI brain imaging epilepsy protocol, and EEG monitoring. All subjects were followed in the epilepsy clinic for at least 6 months. Results 75.8% of patients with lesional epilepsy showed poor response to antiepileptic medications. Cerebromalatic lesions related to brain trauma was the most frequently encountered (21.8%). Malformations of cortical development were significantly associated with poor response to AED (p = 0.040). Polytherapy and the combined use of 1st- and 2nd-generation AED were higher in the poor response group. Logistic regression analysis revealed that younger age at seizure onset and abnormal EEG findings was 0.965 times and 2.5 times more associated with poor seizure control, respectively. Conclusion This study revealed that patients with lesional epilepsy who develop seizures in their early life, who suffer from malformations of cortical development, or who show abnormal EEG findings are more suspected to show poor response to AED.

Abstract Background To report a case of sudden onset left upper limb monoplegia, convulsions, and bilateral blindness in a patient receiving tacrolimus for immunosuppression following living donor liver transplantation (LDLT) consistent with posterior reversible encephalopathy syndrome (PRES). Case presentation We report a case of a 64-year-old male patient on tacrolimus treatment following LDLT. On day 11, during his post-operative routine follow-up. The patient developed sudden onset of left upper limb monoplegia associated with attacks of convulsions and sudden bilateral blindness. MRI revealed multiple, bilateral cortical, and subcortical areas of high T2 and FLAIR signal intensity that did not show restricted diffusion. Findings were suggestive of posterior reversible encephalopathy syndrome (PRES). After the cessation of tacrolimus, vision was completely regained and all other neurologic symptoms were resolved, and follow-up MRI was normal. This case represents an uncommon presentation of tacrolimus toxicity. Conclusion Tacrolimus toxicity may present with PRES. Neurological deficits may be fully reversible with discontinuation of the drug; therefore, the early recognition and prompt management of this condition are of utmost importance.

Numerous case reports and case series have described brain Magnetic Resonance Imaging (MRI) findings in Coronavirus disease 2019 (COVID-19) patients with concurrent posterior reversible encephalopathy syndrome (PRES). We aim to compile and analyze brain MRI findings in patients with COVID-19 disease and PRES. PubMed and Embase were searched on April 5th, 2021 using the terms "COVID-19", "PRES", "SARS-CoV-2" for peer-reviewed publications describing brain MRI findings in patients 21 years of age or older with evidence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and PRES. Twenty manuscripts were included in the analysis, which included descriptions of 30 patients. The average age was 57 years old. Twenty-four patients (80%) required mechanical ventilation. On brain MRI examinations, 15 (50%) and 7 (23%) of patients exhibited superimposed foci of hemorrhage and restricted diffusion respectively. PRES is a potential neurological complication of COVID-19 related disease. COVID-19 patients with PRES may exhibit similar to mildly greater rates of superimposed hemorrhage compared to non-COVID-19 PRES patients. • PRES is a potential neurological complication of COVID-19 disease. • Compared to non-COVID-19 PRES patients, COVID-19 patients with PRES may exhibit similar to mildly greater rates of superimposed hemorrhage. • Compared to non-COVID-19 PRES patients, COVID-19 patients with PRES exhibit comparable rates of restricted diffusion. [ABSTRACT FROM AUTHOR]

Urgent direct access to diagnostic services for general practitioners (GPs) is a new pathway to capture any cancer diagnoses that may have been missed due to vague symptom presentations. Hence, GPs should look out for the key symptoms mentioned by NHS England that should prompt urgent direct access referrals for chest X-ray (CXR), computed tomography (CT) chest, MRI brain, ultrasound (US) abdomen and pelvis, and CT abdomen and pelvis. By implementing this approach, we can significantly reduce the time to diagnosis, while minimizing the number of visits to GP and specialist appointments prior to initiating investigations. However, the use of this pathway can only improve if access to diagnostic scans is improved. This needs to be done by ensuring all GPs in the country have access to directly request MRI brains, CT chest, abdomen, and pelvis. Further research into the impact of the urgent direct access pathway as well as investigating the number of GPs without access to these vital diagnostic services is required to fully improve and measure the progress of this referral pathway., Competing Interests: Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Gurung et al.)

Objective: The volumes of various brain regions can be rapidly quantified using automated magnetic resonance imaging tools. While these appear to be useful at face value, their formal clinical utility is not yet understood, particularly for non-neuroradiologists and in patients presenting with suspected dementia. This study investigated the utility of an automated normative morphometry tool on determinations of brain atrophy by psychiatrists and radiologists in a tertiary hospital. Methods: Consecutive magnetic resonance scans (n = 110) of patients referred with suspected neurodegenerative disorders were obtained retrospectively and rated by two neuroradiologists, two general radiologists and four psychiatrists over two sessions. First, conventional magnetic resonance sequences were shown. Then, morphometry colour-coded maps, which segmented T1-weighted magnetisation prepared rapid gradient echo images into brain regions and visualised these regions in colour according to their volumetric standard deviation from a normative population, were added to the second reading which occurred ⩾6 weeks later. Presence and laterality of atrophy in frontal, parietal and temporal lobes and hippocampal regions were measured using a digital checklist. The primary outcome of inter-rater agreement on atrophy was measured with Fleiss' Kappa (κ). We also evaluated the accuracy of the atrophy ratings for differentiating post hoc diagnosis of subjective cognitive impairment, mild cognitive impairment and dementia. Results: Agreement among all raters was fair in frontal lobe and moderate in other regions with conventional method (κ = 0.362–0.555). With morphometry, higher agreement was seen in all regions (κ = 0.551–0.654), reaching significant improvement in the frontal and temporal lobes. No significant improvement was seen within the various disciplines, except in frontal lobes rated by psychiatrists. Accuracy of atrophy ratings on determining post hoc diagnosis was significantly improved for distinguishing subjective cognitive impairment versus dementia. Conclusion: In routine clinical assessment, automated normative morphometry complements the determination of regional atrophy and improves inter-rater agreement regardless of neuroradiology experience. [ABSTRACT FROM AUTHOR]

• A case report describes a 15-year old young woman with cognitive impairment, muscle weakness, autistic spectrum disorder, biochemical abnormalities, homoplasmic variant by WES testing of m. 8993 T>G, and normal MRI findings. • Neuropsychological testing revealed overall IQ to be 69, low verbal comprehension, neurocognitive processing speed and working memory. • Biochemical abnormalities of repetitive findings of elevated serum lactate, plasma alanine, C3 and 5OH on acyl carnitine profile, and low citrulline on plasma amino acid analysis. • Normal MRI findings at age 2 and 14 years of age. Leigh syndrome is a progressive neurodegenerative syndrome caused by multiple mitochondrial DNA and nuclear DNA pathological variants. Patients with Leigh syndrome consistently have distinct brain lesions found on MRI scanning involving abnormal signal in the basal ganglia, brainstem and/or cerebellum. Other clinical findings vary depending on the genetic etiology and epigenetic factors. Mitochondrial DNA-derived Leigh syndrome phenotype is thought to be modulated by heteroplasmy level. The classic example is the clinical expression of the pathological variant, m. 8993 T>G. At heteroplasmy levels above 90%, the resulting phenotype is Leigh syndrome, but at levels 70–90% patients present with a syndrome of neuropathy, ataxia and retinitis pigmentosa. We describe a 15-year old girl with homoplasmic variant in m.8993 T>G and clinical and biochemical findings consistent with Leigh syndrome but with normal brain MRI findings and without retinal abnormalities or ataxia. [ABSTRACT FROM AUTHOR]

Hemophagocytic lymphohistiocytosis (HLH) is a rare multisystem condition associated with uncontrolled overproduction and infiltration of lymphocytes and histiocytes predominantly in liver, lymph nodes, spleen, and central nervous system. Neuroimaging findings on MRI are fairly nonspecific and classically include periventricular white matter signal abnormalities and diffuse atrophy. Focal parenchymal lesions may demonstrate post contrast ring or nodular enhancement and calcification. However, the MR imaging characteristics can be highly variable. Here, we present two cases of HLH in infants with multiple hemorrhagic lesions mostly depicted in both thalami and basal ganglia regions. Thalamic, basal ganglia, and brain stem involvement with hemorrhagic changes in HLH are rarely described in literature. Early diagnosis of HLH may be lifesaving. Awareness of the disease is necessary to investigate its characteristic findings and avoiding a delay in diagnosis. [ABSTRACT FROM AUTHOR]

Introduction: Hypotonia is a common presentation that child neurologists encounter daily. The hypotonic neonate represents a diagnostic challenge as a lesion at any level in the neuro-axis may cause hypotonia. In this paper, we study the diagnostic yield of investigations commonly used as part of a hypotonia work-up. Methods: A 12-year retrospective cohort study was conducted at a tertiary care center in Saudi Arabia from 2007 to 2018. Final diagnoses, clinical presentations, laboratory tests, imaging and genetic studies were reviewed from the patient's electronic health records. Results: 164 patients were identified as fitting the inclusion criteria of the study. 50% had central hypotonia, 18% peripheral hypotonia and 32% mixed hypotonia. Molecular testing was performed for 82% (74) of patients. 65 Microarray studies were done; 27% abnormal and 9% diagnostic. 55 gene panels were done; 58% abnormal and 30% diagnostic. 53 single-gene tests were done; 57% abnormal and 40% diagnostic. 61 whole exome sequences were done; 72% positive and 59% diagnostic. 126 MRIs were reviewed; 56% abnormal and 33% contributed to the diagnosis. Conclusion: Molecular genetic testing is our recommended next step in the diagnosis of patients with hypotonia after careful phenotyping. Neuroimaging is helpful to guide further costly workup of patients with hypotonia.

The pulmonary manifestations of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection or coronavirus disease 2019 (COVID-19) are well known. The literature on neurological manifestations and complications in patients with COVID-19 has been increasing but is still sparse. At present, there are only a few reported case reports and clinical studies on neurological manifestations of COVID-19, of which ischemic stroke is one of the most common ones. Coagulopathy and vascular endothelial dysfunction have been proposed as the complications of COVID-19 which can ultimately lead to ischemic stroke. In this case report, we present a case of multifocal ischemic stroke in a patient with COVID-19. This patient had persistent encephalopathy and dysarthria after recovering from hypoxic respiratory failure and subsequently developed ischemic stroke in multiple vascular territories during hospital admission. • Hypercoagulopathy and vascular endothelial dysfunction have been proposed as complications of COVID 19 which can lead to stroke. • Diagnoses of stroke in critically ill patients hospitalized with COVID-19 using MRI brain can be challenging due to multiple factors. • Patient with COVID-19 with stroke in multiple vascular territories after he had persistent encephalopathy and dysarthria. • MRI brain is more sensitive and specific modality to detect brain tissue that has been damaged by an ischemic stroke than a CT head. [ABSTRACT FROM AUTHOR]

Background: Wilson disease (WD), a potentially treatable genetic disorder with perturbations in copper metabolism, presents with hepatic and neuropsychiatric manifestations. Both hyper and hypokinetic movements predominate the latter spectrum. Motor stereotypies, however, are exceedingly rare. Case Report: We present a case of a 12-year-old girl, with progressive behavioural alterations and cognitive impairment, with motor stereotypies involving the upper limbs, as the dominant movement semiology. She was diagnosed as WD with evidence of striatal involvement on brain imaging. Her motor symptoms partially responded to chelation therapy. Discussion: There are about five documented cases of motor stereotypies in WD worldwide, with only one being previously reported from India. [ABSTRACT FROM AUTHOR]

Background: Idiopathic or Benign intracranial hypertension (IIH) is a disorder of unknown etiology characterized by raised CSF pressure and is primarily a diagnosis of exclusion. Aim and objectives: To describe the radiological features of idiopathic intracranial hypertension and the frequency and contribution of each finding for the diagnosis of this condition and correlate clinical features with the radiological findings. Materials and methods: Prospective observational study was done in 50 patients with the diagnosis of IIH satisfying the modified Dandys criteria. Results: Females were predominant headache and papilledema was present in all patients. Slit like frontal horns of bilateral lateral ventricle and empty sella related to the raised intracranial pressure were found in all the patients. In our study, mean CSF pressure was 315.1 mm of H2O. Patients with Visual disturbances had higher mean CSF pressures - 327.6 mm H2O. Mean CSF pressure in patients with VI cranial nerve palsy was 347.4 mm H2O. Conclusion: In our study, majority of our patients were in 2nd - 3rd decade with high female preponderance and headache is the universal presenting symptom in all patients, followed by diplopia and visual disturbances. All of them had papilledema as a predominant finding. Patients with higher CSF pressure tend to have Vision loss and VI cranial nerve palsy. In our study, slit like ventricles and empty sella was present in all the patients. IIH is a less understood and studied entity, which presents with nonspecific symptoms and subtle radiological signs. Prompt diagnosis with adequate treatment can lead to significant improvement in the clinical condition of the patient. According to our study, slit like ventricles, empty sella, vertical kinking of optic nerve, prominence of CSF space around optic nerve and venous sinus abnormalities detected on MRI are important neuroradiological markers of IIH. [ABSTRACT FROM AUTHOR]