| 1. |
- Abul-Kasim, Kasim, et al.
(författare)
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Combined Clinical and Radiological Prognostic Model in Acute Ischemic Stroke
- 2010
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Ingår i: Acta Neurologica Belgica. - 2240-2993. ; 110:3, s. 239-245
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Tidskriftsartikel (refereegranskat)abstract
- We sought to propose and test the validity of a comprehensive prognostic model in middle cerebral artery-stroke treated with Intravenous thrombolysis. A total of 127 consecutive patients (aged 70 +/- 12 years; 54% males) were included in this retrospective study. Variables included in our prognostic model were: NIHSS on admission (1-3 points), occurrence of hyperdense middle cerebral artery sign and early ischemic signs on baseline CT (1 point each). NIHSS at 24 hours (0-3 points), posttreatment hemorrhage (1 point), and infarct volume (0-4 points). The score range teas 1-13, with higher values suggest unfavorable prognosis. Our prognostic score was correlated with the modified Rankin scale (mRS) at 3 months after stroke [correlation coefficient of 0.62, P < 0.001] and can thus help early prediction of the functional outcome. Logistic regression showed that NIHSS at 24 hours and EICs on baseline CT were independent predictor of our prognostic score (adjusted odds ratio of 4.1 and 5). Adopting a cut-off value of prognostic score <= 3 for favorable prognosis and >= 7 for unfavorable prognosis helped to predict the need for institutionalization and the functional outcome with higher accuracy and predictive values compared with using scores only based on NIHSS.
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| 2. |
- Abul-Kasim, Kasim, et al.
(författare)
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Differentialdiagnoser
- 2010
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Bok (övrigt vetenskapligt/konstnärligt)
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| 3. |
- Abul-Kasim, Kasim, et al.
(författare)
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Radiological and clinical outcome of screw placement in adolescent idiopathic scoliosis: evaluation with low-dose computed tomography.
- 2010
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Ingår i: European Spine Journal. - : Springer Science and Business Media LLC. - 0940-6719 .- 1432-0932. ; 19:1, s. 96-104
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Tidskriftsartikel (refereegranskat)abstract
- Posterior corrective surgery using "all pedicle screw construct" carries risk of neurovascular complications. The study aims were to assess the screw placement in patients with adolescent idiopathic scoliosis using CT with low-radiation dose, and to evaluate the clinical outcome in patients with misplaced pedicle screws. CTs of 49 consecutive patients (873 screws, 79% thoracic) were retrospectively evaluated by two independent radiologists. A new grading system was developed to distinguish between lateral, medial and anterior cortical perforations, endplate perforation and foraminal perforation. The grading system is based on whether the cortical violation is partial or total rather than on mm-basis. The overall rate of screw misplacement was 17% (n = 149): 8% were laterally placed and 6.1% were medially placed. The rates of anterior cortical, endplate and foraminal perforation were 1.5, 0.9, and 0.5%, respectively. Lateral cortical perforation was more frequent in the thoracic spine (P = 0.005), whereas other types of misplacement including medial cortical perforation were more frequent on the left and the concave side of scoliotic curves (P = 0.002 and 0.003). No neurovascular complications were reported. The association between the occurrence of screw misplacement and the Cobb angle was statistically significant (P = 0.037). Misplacements exceeding half screw diameter should be classified as unacceptable. Low-dose CT implies exposing these young individuals to a significantly lower radiation dose than do other protocols used in daily clinical practice. We recommend using low-dose CT and the grading system proposed here in the postoperative assessment of screw placement.
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| 4. |
- Abul-Kasim, Kasim, et al.
(författare)
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Spinal Cord Injuries
- 2010
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Ingår i: Trauma to the spinal cord.. - 9781608760022 ; , s. 483-499
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Bokkapitel (refereegranskat)abstract
- Spinal cord injury can be classified as traumatic and non-traumatic. The traumatic spinal cord injuries (SCI) are caused by motor vehicle accidents (56 %), falls (14 %), firearm and violence-related (16.6 %) and sports injuries (7 %) [1]. Injuries after falls and minor trauma are more commonly seen in elderly patients as they more often have spondylosis and osteoporosis. Violence is more common in urban populations while sports injuries are common in young individuals. About 68 % of children involved in spinal cord injuries caused by motor vehicle accidents were not wearing a seatbelt. Almost 80% of patients with spinal cord injury had multiple injuries [2]. Associated injuries include other bone fractures(29.3 %) and brain injury (11.5 %) [3]. Other causes of spinal cord injuries are non-traumatic and include the following: vascular disorders, degenerative disorders, spinal tumors, infectious and inflammatory conditions of the vertebral column with secondary SCI as well as iatrogenic injuries after spinal injections and epidural catheter. Three possible mechanisms are believed to be involved in the development of spinal cord injuries [4]: (a) damage from direct trauma, (b) compression or transaction of neural elements by bone fragments, intraspinal hematoma, foreign bodies, or protruded disk, or (c) ischemia from damage of the spinal arteries or from venous congestion. As small arteries are disrupted by trauma, spinal cord swelling occurs within minutes after the trauma with resultant venous congestion and secondary ischemia. Cell death occurs days to weeks after the injury with involvement of the oligodendrocytes not only at the site of injury but also at several levels away from the injury site [5]. Following the primary spinal cord injury, a cascade of secondary injuries usually are initiated [6] resulting in: (a) vascular changes—ischemia, hemorrhage, and thrombosis [7], (b) Disturbance of electrolyte balance with accumulation of intracellular sodium resulting in edema [8], (c) accumulation of neurotransmitters and toxins edema [8], (d) inflammation [9], and (e) apoptosis.
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| 5. |
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| 6. |
- Cagnoli, Patricia C, et al.
(författare)
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Changes in Regional Brain Morphology in Neuropsychiatric Systemic Lupus Erythematosus.
- 2012
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Ingår i: Journal of Rheumatology. - : The Journal of Rheumatology. - 0315-162X .- 1499-2752. ; 39:5, s. 959-967
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: Neuropsychiatric lupus (NPSLE) is a severe and potentially life-threatening condition, reported to occur in 25%-70% of patients with systemic lupus erythematosus (SLE). Brain imaging, especially magnetic resonance imaging, is frequently used to diagnose or exclude overt cerebral pathologies such as edema, hemorrhage, and central thrombosis. More advanced imaging techniques have been applied to demonstrate subtle changes in regional cerebral blood flow and brain structure. We investigated changes in regional gray-matter (GM) volume in SLE patients without neurological manifestations and NPSLE patients at an acute stage of the disease. METHODS: Using high-resolution structural images and voxel-based morphometry (VBM), we investigated regional GM volume in 20 NPSLE patients (within 2 weeks of the acute manifestation), 18 SLE patients without neurologic and/or psychiatric manifestations, and 18 healthy controls. RESULTS: VBM analyses revealed several regions of GM atrophy in various parts of the brain in NPSLE and SLE patients. GM atrophy was seen in both groups in the temporal and parietal lobes and was most pronounced in the posterior thalamus bilaterally. Both groups showed an increase in regional GM volume in the posterior parahippocampal gyrus. CONCLUSION: Our data suggest that changes in regional brain morphology are present in acute NPSLE, but also in SLE (as compared to controls), which might be indicative of a subclinical neurodegenerative process. Further research is needed to investigate whether specific neuropsychiatric symptoms are related to these changes.
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| 7. |
- Cagnoli, Patricia, et al.
(författare)
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Reduced Insular Glutamine and N-Acetylaspartate in Systemic Lupus Erythematosus: A Single-Voxel H-1-MR Spectroscopy Study
- 2013
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Ingår i: Academic Radiology. - : Elsevier BV. - 1878-4046 .- 1076-6332. ; 20:10, s. 1286-1296
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Tidskriftsartikel (refereegranskat)abstract
- Rationale and Objectives: To investigate for differences in metabolic concentrations and ratios between patients with systemic lupus erythematosus (SLE) without (group SLE) and those with neurological symptoms (group NPSLE) compared to a healthy control (group HC) in three normal-appearing brain regions: the frontal white matter, right insula (RI), and occipital gray matter and whether changes in any of the metabolites or metabolic ratios are correlated to disease activity and other clinical parameters. Materials and Methods: Twenty patients with SLE (18 women and 2 men, age range 23.4-64.6 years, mean age 43.9 years), 23 NPSLE patients (23 women, age range 23.7-69.8 years, mean age 42.4 years), and 21 HC (19 women and 2 men, age range 21.0-65.7 years, mean age 43.4 years) were included. All subjects had conventional brain magnetic resonance imaging and H-1 single-voxel spectroscopy, clinical assessment, and laboratory testing. Results: NPSLE patients had significantly reduced N-acetylaspartate (NAA)/creatine compared to HC (P = .02) and SLE patients (P = .01) in the RI. Lower glutamine/creatine levels were also detected in RI in both patient groups and in frontal white matter in NPSLE patients compared to HC (P = .01, P = .02). NAA/Cr ratio in the RI was significantly negatively correlated with the Systemic Lupus Erythematosus Disease Activity Index (r = -0.41; P = .008), and patients with active SLE symptoms also had a trend toward lower NAA/creatine ratios (1.02 vs 1.12; P = .07). Conclusions: The present data support previous findings of abnormal metabolic changes in normal-appearing regions in the brain of both SLE and NPSLE patients and raise the possibility that especially NAA, glutamine, and glutamate may be additional biomarkers for cerebral disease activity in SLE patients as these early metabolic changes occur in the brain of SLE patients before neurologic and imaging manifestations become apparent.
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| 8. |
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| 9. |
- Chapman, Christopher H., et al.
(författare)
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Diffusion Tensor Imaging of Normal-Appearing White Matter as Biomarker for Radiation-Induced Late Delayed Cognitive Decline
- 2012
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Ingår i: International Journal of Radiation Oncology, Biology, Physics. - : Elsevier BV. - 0360-3016. ; 82:5, s. 2033-2040
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Tidskriftsartikel (refereegranskat)abstract
- Purpose: To determine whether early assessment of cerebral white matter degradation can predict late delayed cognitive decline after radiotherapy (RT). Methods and Materials: Ten patients undergoing conformal fractionated brain RT participated in a prospective diffusion tensor magnetic resonance imaging study. Magnetic resonance imaging studies were acquired before RT, at 3 and 6 weeks during RT, and 10, 30, and 78 weeks after starting RT. The diffusivity variables in the parahippocampal cingulum bundle and temporal lobe white matter were computed. A quality-of-life survey and neuro-cognitive function tests were administered before and after RT at the magnetic resonance imaging follow-up visits. Results: In both structures, longitudinal diffusivity (lambda(parallel to)) decreased and perpendicular diffusivity (lambda(perpendicular to)) increased after RT, with early changes correlating to later changes (p < .05). The radiation dose correlated with an increase in cingulum lambda(perpendicular to) at 3 weeks, and patients with >50% of cingula volume receiving >12 Gy had a greater increase in lambda(perpendicular to) at 3 and 6 weeks (p < .05). The post-RT changes in verbal recall scores correlated linearly with the late changes in cingulum lambda(parallel to) (30 weeks, p < .02). Using receiver operating characteristic curves, early cingulum lambda(parallel to) changes predicted for post-RT changes in verbal recall scores (3 and 6 weeks, p < .05). The neurocognitive test scores correlated significantly with the quality-of-life survey results. Conclusions: The correlation between early diffusivity changes in the parahippocampal cingulum and the late decline in verbal recall suggests that diffusion tensor imaging might be useful as a biomarker for predicting late delayed cognitive decline. (C) 2012 Elsevier Inc.
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| 10. |
- Elias, Augusto E., et al.
(författare)
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MR Spectroscopy Using Normalized and Non-normalized Metabolite Ratios for Differentiating Recurrent Brain Tumor from Radiation Injury
- 2011
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Ingår i: Academic Radiology. - : Elsevier BV. - 1878-4046 .- 1076-6332. ; 18:9, s. 1101-1108
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Tidskriftsartikel (refereegranskat)abstract
- Rationale and Objectives: To compare the ability of normalized versus non-normalized metabolite ratios to differentiate recurrent brain tumor from radiation injury using magnetic resonance spectroscopy (MRS) in previously treated patients. Materials and Methods: Twenty-five patients with previous diagnosis of primary intracranial neoplasm confirmed with biopsy/resection, previously treated with radiation therapy (range, 54-70 Gy) with or without chemotherapy and new contrast enhancing lesion on a 1.5 T magnetic resonance imaging at the site of the primary neoplasm participated in this retrospective study. After MRS, clinical, radiological, and histopathology data were used to classify new contrast-enhancing lesions as either recurrent neoplasm or radiation injury. Volume of interest included both the lesion and normal-appearing brain on the contralateral side. Non-normalized metabolic ratios were calculated from choline (Cho), creatine (Cr), and N-acetylaspartate (NAA) spectroscopic values obtained within the contrast-enhancing lesion: Cho/Cr, NAA/Cr, and Cho/NAA. Normalized ratios were calculated using the metabolic values from the contralateral normal side: Cho/normal creatinine (nCr), Cho/normal N-acetylaspartate (nNAA), Cho/normal choline, NAA/nNAA, NAA/nCr, and Cr/nCr. Results were correlated with the final diagnosis by Wilcoxon rank-sum analysis. Results: Two of three non-normalized ratios, Cho/NAA (sensitivity 86%, specificity 90%) and NAA/Cr (sensitivity 93%, specificity 70%) significantly associated with tumor recurrence even after correcting for multiple comparisons. Of the six normalized ratios, only Cho/nNAA significantly correlated with tumor recurrence (sensitivity 73%, specificity 40%), but did not remain significant after correcting for multiple comparisons. Conclusion: Cho/NAA and NAA/Cr were the two ratios with the best discriminating ability and both had better discriminating ability than their corresponding normalized ratios (Area under the curve = 0.92 versus 0.77, AUC= 0.85 vs. 0.66), respectively.
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