Gray Matter Pathology in MS: A 3-Year Longitudinal Study in a Pediatric Population • M. Calabrese, D. Seppi, C. Romualdi, F. Rinaldi, S. Alessio, P. Perini, and P. Gallo
Gray matter lesions are common in adult patients with MS. These authors assessed 92 children within 12 months of onset and every 3 years thereafter for this type of lesion. They found that cortical lesions and diffuse gray matter atrophy were associated with the biologic onset of MS and preceded linearly and independently of white matter lesions. The findings support the concept that MS should be considered as a “2-component“ disease in which gray matter damage occurs separately from white matter damage.
Differentiation of Pyogenic Brain Abscesses from Necrotic Glioblastomas with Use of Susceptibility-Weighted Imaging • C.H. Toh, K.-C. Wei, C.-N. Chang, P.-W. Hsu, H.-F. Wong, S.-H. Ng, M. Castillo, and C.-P. Lin
In this article the authors used SWI to evaluate the hypointense peripheral rim seen in both glioblastomas and pyogenic abscesses. Studying 12 abscesses and 20 glioblastomas, they discovered the rims were complete and had smooth contours more commonly in the former. An unexpected sign that was only seen in abscesses was that of a dual rim of hypointensity surrounding the lesions. They concluded that SWI is helpful in separating these 2 entities and the most specific sign was the dual rim.
Subcortical and Cortical Gray Matter Atrophy in a Large Sample of Patients with Clinically Isolated Syndrome and Early Relapsing-Remitting Multiple Sclerosis • N. Bergsland, D. Horakova, M.G. Dwyer, O. Dolezal, Z.K. Seidl, M. Vaneckova, J. Krasensky, E. Havrdova, and R. Zivadinov
Brain atrophy is commonly seen in patients with chronic MS. Here, the authors assessed 212 patients with clinically isolated syndrome and early RRMS for atrophy of gray matter. In both groups the cortex displayed no significant atrophy but the deep gray matter nuclei (caudate, thalamus, globus pallidus, putamen, and hippocampus) showed significant atrophy during the first 4 years of the disease. Deep gray matter atrophy may play a relevant role in patient symptoms and seems to appear and progress from the earliest stages of the disease.
Fellows’ Journal Club
A 5-Item Prediction Rule to Identify Severe Renal Dysfunction in Patients with Acute Stroke • M.D.I. Vergouwen, J. Fang, L.K. Casaubon, M.K. Kapral, M. Stamplecoski, A. Robertson, and F.L. Silver , on behalf of the Investigators of the Registry of the Canadian Stroke Network
The authors looked at 5 conditions that predicted severe renal dysfunction in patients with stroke. Because patients with stroke may undergo contrast-enhanced CT and CTA before renal function test results are available, it is important to know who is at risk for contrast-induced neuropathy. The prediction tool assigned the following scores: age in years, 5 points for women, 5 points for diabetes, 15 points for preadmission insulin use, and 10 points for hypertension. Scores < 70 carried negligible risk but scores >111 correlated with a 28% chance of renal dysfunction. Thus, this scale may be used without wasting time waiting for laboratory results.
Vertebral Endplate Changes Are Not Associated with Chronic Low Back Pain among Southern European Subjects: A Case Control Study • F.M. Kovacs, E. Arana, A. Royuela, A. Estremera, G. Amengual, B. Asenjo, H. Sarasíbar, I. Galarraga, A. Alonso, C. Casillas, A. Muriel, C. Martínez, and V. Abraira , for the Spanish Back Pain Research Network
Although vertebral endplate changes are common, their association with back pain is controversial. Nearly 350 patients aged 35–50 years and with low back pain lasting longer than 90 days were studied and subjects without pain served as controls. Vertebral endplate changes were found in 80.4% of patients and in 87.5% of controls. After data analysis, the authors concluded that these changes were not associated with chronic low back pain.
Acute-Onset Migrainous Aura Mimicking Acute Stroke: MR Perfusion Imaging Features • D. Floery, M.R. Vosko, F.A. Fellner, C. Fellner, C. Ginthoer, F. Gruber, G. Ransmayr, A. Doerfler, M. Uder, and W.G. Bradley
Out of 1850 MR studies performed for acute stroke symptoms, 20 were found to have acute migrainous auras that clinically simulated stroke. In 70% of cases perfusion studies showed delayed MTT and TTP, decreased CBF, and minimally decreased CBV in more than one arterial territory. Hypoperfusion was more common posteriorly and 3 patients showed bilateral defects. The authors concluded that acute migraine may produce atypical perfusion stroke-like patterns and thus needs to be included in the differential diagnosis of acute brain infarctions.