Clinical Neuroscience

[APPLICATION OF FUNCTIONAL MR-IMAGES ACQUIRED AT LOW FIELD IN PLANNING OF NEUROSURGICAL OPERATION CLOSE TO AN ELOQUENT BRAIN AREA]

AUER Tibor, SCHWARCZ Attila, JANSZKY József, HORVÁTH Zsolt, KOSZTOLÁNYI Péter, DÓCZI Tamás

JANUARY 20, 2007

Clinical Neuroscience - 2007;60(01-02)

[Aim of the study - Presentation of functional MRI performed at low magnetic field (1 Tesla) for planning microsurgical operation in a patient suffering from tumor close to an eloquent brain area. Methods - Microsurgical removal navigated by frameless stereotaxy of an intrinsic tumor located in eloquent area is indicated if speech function is not damaged, i.e. exact localisation and relationship of the tumor and speech area can be defined. Before operation an optimized EPI based 2D sequence was applied to yield functional MR images. At the planning of the operation the paradigm used for the localization of the sensory language cortex contained passive listening to a text. Control investigations were performed one month postoperatively. A specific psychological test, as an additional investigation to estimate the accurate level of the sensory language function, was also conducted. Results - Low resolution (matrix of 64×64) functional MR images visualized sensory speech center and auditory cortex satisfactorily. The scans showed clearly that the Wernicke's region was situated just above the tumor (WHO grade II glioma), and this finding increased the safety of intraoperative localization and reduced the risk of morbidity. Control examinations revealed minimal decrease in sensory language function, however, it was not noticeable for either the patient or her surroundings. Conclusion - Optimized functional MR imaging performed at low magnetic field can support planning of neurosurgical operations and reduce the morbidity of microsurgical interventions.]

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[A CASE OF SCHIZENCEPHALY WITH POLYMICROGYRIA]

LEEL-ŐSSY Lóránt, SZŰCS Iván, ALMÁSI Kálmán

[A case of extensive bilateral frontotemporal schizencephaly is alleged - more extensively in the left hemisphere - which associated with polymicrogyria. The cortical anomaly was discovered only incidentally by MR examination in a 22 year-old man who suffered from headache due to a mild head trauma. Neurological examination proved to be negative. He had no complaints or symptoms a few weeks later. The developmental anomalies in corticalisation are shortly overviewed in this group together with the possible causing factors. It has been emphasized the importance of the precise intrauterine and/or postpartum differential diagnosis between schizencephaly, porencephaly and other failure in corticalisation.]

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[UNCOMMON MANIFESTATION OF CENTRAL NERVOUS SYSTEM SARCOIDOSIS]

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[Two cases of uncommon manifestation of central nervous system sarcoidosis are reported. A 42 year-old man had a spinal cord sarcoidosis. MRI of the spinal cord showed myelopathy in the cervico-thoracic region, and the T2-weighted image showed increasing signal intensity. Neurological symptoms did not correllate with radiological abnormalities. Neurological manifestation was paucisymptomatic. Half a year later steroid and azatioprin therapy led to almost complet radiological and clinical regression. In the second case we present a 49 year-old woman who had left side internuclear ophthalmoplegia and the brainstem lesion. The patient was proven to have sarcoidosis. In this case no abnormalities were found in brain MRI. Neurological symptoms could not be detected by MRI, probably caused by brainstem parenchymal lesions consisting of microgranulomatosis that is sarcoid "brainstem encephalitis". Neurological symptoms improved after steroid treatment in this case too. In both of the cases pulmonary lymphadenopathy helped to diagnose sarcoidosis. In our cases there were interesting correllations between neurological symptoms and MRI abnormalities. At the spinal cord sarcoidosis the radiological abnormalities were more striking than the clinical manifestation. In the other case we found distinct brainstem symptoms but could not detect MRI abnormalities.]

Clinical Neuroscience

[Celebrating speech on the unveiling of the statue of academic dr. Sántha Kálmán on the 50th anniversary of his death]

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[NONSENSE MUTATION 193C>T OF NEUROFIBROMATOSIS TYPE 2 - A NEUROSURGICAL CHALLENGE]

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[A 15 years old male was operated because of incidentally found intercostal schwannoma. Two years later severe cerebellar ataxy and left sided anacusis developed. MRI revealed bilateral vestibularis tumors and multiple cervical intradural extramedullar myelon compressing lesions. After partial resection of the huge left sided cerebello-pontin tumor, histologically schwannoma, and the exstirpation of the multiple cervical meningiomas the patient died three months later due to septic complications. The 24 years old mother had been operated on similar lesions 12 years earlier, after two weeks postoperative period she died. Her 14 years old twins are living, a boy also with bilateral acustic tumours and a girl who is intact. Genetic investigation revealed C>T nonsense mutation at position 193 in the exon 2 of the NF2 gene. This mutation cause premature truncation of the gene protein and is probably in connection with the clinically severe phenotype. Early diagnosis of this type of neurofibromatosis is mandatory concerning the therapy.]

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[The restless legs syndrome is a disorder belonging to the family of movement disorders during sleep, often remains unrecognized, although it is the second most common cause of chronic sleep deficiency and daytime sleepiness. In accordance with international guidelines, pharmacotherapy of this disorder should begin with a dopamine agonist. Owing to their efficacy and favorable safety profile, newly introduced, selective dopamine agonists have become extensively used for this purpose. This study evaluated the efficacy of one of the products in this group, pramipexole. Fifty-one patients suffering from idiopathic restless legs syndrome underwent monotherapy with pramipexole in daily doses of 0.25 to 1.0 mg. Therapeutic efficacy was evaluated using three tools, i.e. follow-up questionnaires, actigraphy, and Forced Immobilisation Test. An excellent therapeutic effect was seen in more than 80 per cent of the study population. As shown by findings of the follow-up questionnaires, pramipexole resulted in substantial improvements of both daytime and nighttime symptoms of RLS. Actigraphy monitoring demonstrated a statistically significant increase in the ratio of time spent without limb movement to the time spent in bed; furthermore, the result of the Forced Immobilisation Test also improved. It seems fair to conclude from the findings of this study that pramipexole monotherapy is an effective treatment in restless legs syndrome.]

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[For localizing the epileptogenic zone in cases of focal epilepsies detailed clinical investigations, imaging studies and electrophysiological methods are in use. In lesional epilepsies the intrapreoperatíve localization of the lesion and it’s location to the eloquent cortex is essential for the neurosurgeon. The development in image guided neurosurgery lead us to use neuronavigation systems to localize intracerebral lesions or functionally eloquent cortical areas or subcortical pathways during surgery. Neuronavigation brought changes in preoperatíve evaluation and in resective surgery in epilepsy as well. In this article we describe the basics of neuronavigation and enhance the advantages of the technique in epilepsy surgery during the presurgical evaluation with invasive electrodes, in resective surgery and DBS for epilepsy.]

Clinical Neuroscience

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[AIM OF THE STUDY - To perform functional MRI experiments at low magnetic field, and to set up routine protocol to help the planning of neurosurgical operations and the examination of epilepsy patients. METHODS - An optimized 2D EPI sequence was applied to yield functional MR images in basic paradigms such as finger tapping and internal word generation. Further, activation was induced also by a task involving mental navigation based on the retrieval of individually familiar visuo-spatial knowledge. RESULTS - Low resolution (matrix of 64×64) functional MR images satisfactorily visualized moto-sensor strip and speech centers. In the mental navigation task bilateral activation of formatio hippocampalis was observed. Determination of motor area was also performed in an epilepsy patient whose seizure focus had been found in the area of pre- and postcentral gyrus. The dislocation of the motor cortex was demonstrated. CONCLUSION - Functional MR images with fine quality can be obtained in basic paradigms even at low magnetic field if MR imaging parameters and paradigms are optimized.]

Clinical Neuroscience

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Clinical Neuroscience

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[Aim of the study - Presentation of diffusion tensor imaging (DTI) performed at low magnetic field (1 Tesla) in the algorithm of work-up of a patient suffering from severe traumatic brain injury (TBI). Method - DTI and functional MRI (fMRI) were applied at 1 Tesla for visualization of neural pathways and examination of sensory functions of a patient with severe TBI. DTI-measurement was also performed on a healthy patient for comparison. Results - DTI acquired at low magnetic field yielded appropriate visualization of neural pathways. DTI confirmed the results of the clinical and fMRI examinations in the patient suffering from severe TBI. Conclusion - An optimized DTI can be useful in the examination of patients with TBI, moreover, it may also help in the establishment of diagnoses of other central nervous system diseases affecting neuronal pathways. The presented results suggest that DTI of appropriate quality can be performed at low magnetic field.]

Clinical Neuroscience

[APPLICATION OF VERTEBROPLASTY, NEURONAVIGATION AND KYPHOPLASTY IN THE TREATMENT OF MULTIPLEX OSTEOPOROTIC VERTEBRAL FRACTURES - CASE REPORT]

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