scholarly journals Dynamic MRI follow-up of radiation encephalopathy in the temporal lobe following nasopharyngeal carcinoma radiotherapy

2017 ◽  
Vol 14 (1) ◽  
pp. 715-724 ◽  
Author(s):  
Xiaofeng Zhou ◽  
Xiaofang Liao ◽  
Xiaoqiu Ren ◽  
Kewei Xiang ◽  
Qiongge Hu ◽  
...  
Keyword(s):  
Nasopharyngeal Carcinoma ◽  
Temporal Lobe ◽  
Dynamic Mri ◽  
Radiation Encephalopathy

Results of excision of cerebral radionecrosis: experience in patients treated with radiation therapy for nasopharyngeal carcinoma

2010 ◽  
Vol 113 (2) ◽  
pp. 293-300 ◽  
Author(s):  
Sui-To Wong ◽  
Ka-Tai Loo ◽  
Kwong-Yui Yam ◽  
Wai-Man Hung ◽  
Kam-Fuk Fok ◽  
...  
Keyword(s):  
Nasopharyngeal Carcinoma ◽  
Brain Edema ◽  
Temporal Lobe ◽  
Mass Effect ◽  
Karnofsky Performance Scale ◽  
Low Incidence ◽  
Indications For Operation ◽  
Age Range ◽  
Reoperation Rates

Object In theory, the purpose of the treatment of cerebral radionecrosis (CRN), a nonneoplastic condition, is to minimize loss of brain function by preventing the progression and reversing some of the processes of CRN. In a practical sense, factors for achieving this purpose may include the following: removal of a CRN lesion that is causing mass effect, control of brain edema, prevention of recurrence of CRN lesions, minimization of adverse effects from treatments, and achievement of reasonably long and good-quality survivals. Based on these practical issues, the authors performed a retrospective study to evaluate the results of excision for the treatment of CRN. Methods The authors retrospectively reviewed the results of excision of CRN lesions in a group of patients with temporal lobe CRN due to radiotherapy for nasopharyngeal carcinoma. Patients who had undergone surgery at the authors' institution between January 1998 and November 2008 were analyzed. Surgical results were evaluated by assessing postoperative resolution of brain edema, recurrence of temporal lobe CRN, surgery-related complications, and postoperative functional status and survival. Results Twenty-four patients were included (age range 39–69 years; in 23 patients nasopharyngeal carcinoma was in remission). All patients underwent craniotomy for excision of the contrast-enhancing region. The indications for operation were temporal lobe CRN lesions with a mass-occupying effect beyond the temporal lobe. There were 32 craniotomies in all (mean postoperative follow-up 40 months). It was found that brain edema resolved rapidly postoperatively. The recurrence and reoperation rates were 6.3 and 3.1%, respectively. There were no surgery-related deaths. The median survival was 72 months, and 67% of the patients had a Karnofsky Performance Scale score of ≥ 70% at the time of their last follow-up. Conclusions In a specific group of patients with CRN of the temporal lobe in whom the CRN lesions were causing a mass-occupying effect beyond the temporal lobe, excision of the contrast-enhancing region was safe and could achieve prompt resolution of brain edema and a low incidence of recurrence of CRN.

scholarly journals Surface-Based Falff: A Potential Novel Biomarker for Prediction of Radiation Encephalopathy in Patients With Nasopharyngeal Carcinoma

2021 ◽  
Vol 15 ◽  
Author(s):  
You-ming Zhang ◽  
Ya-fei Kang ◽  
Jun-jie Zeng ◽  
Li Li ◽  
Jian-ming Gao ◽  
...  
Keyword(s):  
Nasopharyngeal Carcinoma ◽  
Low Frequency ◽  
Superior Temporal Gyrus ◽  
Brain Regions ◽  
Imaging Biomarker ◽  
Support Vector ◽  
Radiation Encephalopathy ◽  
Radiation Induced

Radiation encephalopathy (RE) is an important potential complication in patients with nasopharyngeal carcinoma (NPC) who undergo radiotherapy (RT) that can affect the quality of life. However, a functional imaging biomarker of pre-symptomatic RE has not yet been established. This study aimed to assess radiation-induced gray matter functional alterations and explore fractional amplitude of low-frequency fluctuation (fALFF) as an imaging biomarker for predicting or diagnosing RE in patients with NPC. A total of 60 patients with NPC were examined, 21 in the pre-RT cohort and 39 in the post-RT cohort. Patients in the post-RT cohort were further divided into two subgroups according to the occurrence of RE in follow-up: post-RT non−RE (n = 21) and post-RT REprovedinfollow−up (n = 18). Surface-based and volume-based fALFF were used to detect radiation-induced functional alterations. Functional derived features were then adopted to construct a predictive model for the diagnosis of RE. We observed that surface-based fALFF could sensitively detect radiation-induced functional alterations in the intratemporal brain regions (such as the hippocampus and superior temporal gyrus), as well as the extratemporal regions (such as the insula and prefrontal lobe); however, no significant intergroup differences were observed using volume-based fALFF. No significant correlation between fALFF and radiation dose to the ipsilateral temporal lobe was observed. Support vector machine (SVM) analysis revealed that surface-based fALFF in the bilateral superior temporal gyri and left insula exhibited impressive performance (accuracy = 80.49%) in identifying patients likely to develop RE. We conclude that surface-based fALFF may serve as a sensitive imaging biomarker in the prediction of RE.

Radiosurgery for dural carotid-cavernous sinus fistulas: Gamma Knife compared with XKnife radiosurgery

2010 ◽  
Vol 113 (Special_Supplement) ◽  
pp. 9-20 ◽  
Author(s):  
Hung-Chuan Pan ◽  
Ming-Hsi Sun ◽  
Jason Sheehan ◽  
Meei-Ling Sheu ◽  
Clayton Chi-Chang Chen ◽  
...  
Keyword(s):  
Clinical Improvement ◽  
Gamma Knife ◽  
Temporal Lobe ◽  
Treatment Modalities ◽  
Conformity Index ◽  
Index Number ◽  
The Mean ◽  
Instrument Accuracy ◽  
Group 1

Object In the modern era, stereotactic radiosurgery is an important part of the multidisciplinary and multimodality approach used to treat dural carotid-cavernous fistulas (DCCFs). Based on the ease of performance of techniques to fuse cerebral angiography studies with MR images or CT scans during the radiosurgical procedure, the Gamma Knife and XKnife are 2 of the most popular radiosurgical instruments for patients with DCCF. In this study, the authors compared the efficacy, neurological results, and complications associated with these 2 radiosurgical devices when used for DCCF. Methods Records for 41 patients with DCCF (15 treated using the XKnife and 26 with Gamma Knife surgery [GKS]) were retrieved from a radiosurgical database encompassing the period of September 2000 to August 2008. Among these patients, at least 2 consecutive MR imaging or MR angiography studies obtained after radiosurgery were available for determining radiological outcome of the fistula. All patients received regular follow-up to evaluate the neurological and ophthalmological function at an interval of 1–3 months. The symptomatology, obliteration rate, radiation dose, instrument accuracy, and adverse effects were determined for each group and compared between 2 groups. The data were analyzed using the Student t-test. Results The mean age of the patients was 63 ± 2.6 years, and the mean follow-up period was 63.1 ± 4.4 months (mean ± SD). Thirty-seven patients (90%) achieved an obliteration of the DCCF (93% in the XKnife cohort and 88% for the GKS cohort). In 34 of 40 patients (85%) with chemosis and proptosis of the eyes, these symptoms were resolved after treatment (4 had residual fistula and 2 had arterializations of sclera). All 5 patients with high intraocular pressure demonstrated clinical improvement. Ten (71%) of 14 patients with cranial nerve palsy demonstrated improvement following radiosurgery. Significant discrepancies of treatment modalities existed between the XKnife and GKS groups, such as radiation volume, conformity index, number of isocenters, instrument accuracy, peripheral isodose line, and maximum dosage. The XKnife delivered significantly higher radiation dosage to the lens, optic nerve, optic chiasm, bilateral temporal lobe, and brainstem. Few adverse events occurred, but included 1 patient with optic neuritis (GKS group), 1 intracranial hemorrhage (XKnife group), 1 brainstem edema (XKnife), and 3 temporal lobe radiation edemas (XKnife). Conclusions Radiosurgery affords a substantial chance of radiological and clinical improvement in patients with DCCFs. The Gamma Knife and XKnife demonstrated similar efficacy in the obliteration of DCCFs. However, a slightly higher incidence of complications occurred in the XKnife group.

AB1294 Psoriatic arthritis - a follow-up study applying dynamic MRI, conventional MRI and clinical measures:

2013 ◽  
Vol 71 (Suppl 3) ◽  
pp. 711.14-711
Author(s):  
R.P. Poggenborg ◽  
P. Bøyesen ◽  
C. Wiell ◽  
S.J. Pedersen ◽  
I.J. Sørensen ◽  
...  
Keyword(s):  
Psoriatic Arthritis ◽  
Dynamic Mri ◽  
Follow Up Study ◽  
Conventional Mri ◽  
Clinical Measures

scholarly journals 346. Eastern Equine Encephalitis and Use of Intravenous Immunoglobulin Therapy and High-Dose Steroids

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S242-S243
Author(s):  
Sarah I Collens ◽  
Douglas R Wilcox ◽  
Shibani Mukerji ◽  
Farrah J Mateen ◽  
Isaac H Solomon
Keyword(s):  
Cerebrospinal Fluid ◽  
Temporal Lobe ◽  
Standard Of Care ◽  
High Dose ◽  
High Morbidity ◽  
Intravenous Immunoglobulin Therapy ◽  
Eastern Equine Encephalitis ◽  
Neuroanatomical Region ◽  
Ivig Administration

Abstract Background Eastern equine encephalitis (EEE) is a mosquito-borne viral infection with significant neurological morbidity and mortality. The clinical presentation and patient outcomes after treatment with IVIG, high-dose steroids, or standard of care alone in EEE remains unclear. Methods A retrospective observational study of patients admitted to two tertiary academic medical centers in Boston, Massachusetts with EEE from 2005 to 2019. Results Of 17 patients (mean [SD] age, 50 [26] years; 10 (59%) male, and 16 (94%) White race), 17 patients had fever (100%), 15 had encephalopathy (88%), and 12 had headache (71%). Eleven of 14 patients with cerebrospinal fluid (CSF) cell count differential had a neutrophil predominance (mean [SD], 60.6% of white blood cells [22.8]) with an elevated protein level (mean [SD], 112 mg/dL [48.8]). Affected neuroanatomical regions included the basal ganglia (n=9/17), thalamus (n=7/17), and mesial temporal lobe (n=7/17). A total of 11 patients (65%) received IVIG; 8 (47%) received steroids. Of the patients who received IVIG, increased time from hospital admission to IVIG administration correlated with worse long-term disability as assessed by modified Rankin Score (mRS) (r=0.72, p=0.02); steroid use was not associated with mRS score. The mortality was 12%. Figure 1. Imaging Characteristics: Typical Pattern of MRI Involvement and Affected Neuroanatomical Regions in Patients with Eastern Equine Encephalitis. All images displayed are the T2-FLAIR sequence. (A) Representative images of pattern of typical neuroanatomical region involved in one patient with demonstrated involvement of the temporal lobe and pons, temporal lobe and midbrain, and basal gangial by T2-FLAIR hyperintensity (panels left to right). (B) Representative images of patients with mild (mRS 0–2), moderate (mRS 3–4), and severe (mRS 5–6) disability score at discharge. (C) Representative images of one patient over course of hospitalization at days 1, 4, and 10 after admission. (D) Quantification of neuroanatomical region involvement in initial MRI of patients with EEE as determined by T2-FLAIR hyperintensity. An area was scored as abnormal only once per patient. Figure 2. Outcomes in Patients with Eastern Equine Encephalitis. Patient disability by modified Rankin Score (mRS) of EEE patients at admission to the hospital, discharge from the hospital, and last recorded follow-up (A). Time to IVIG administration compared to mRS at discharge (B), and most recent clinical follow-up (C). Table 1. Demographics, Clinical Characteristics, and Laboratory Data in Patients with Eastern Equine Encephalitis. Abbreviations: CSF = cerebrospinal fluid, WBC = white clood count, EEG = electroencephalogram, ALT = alanine aminotransferase, AST = aspartate transaminase. Demographic data was collected for all patients with confirmed EEE. Altered mental status included any description of encephalopathy, confusion, or difficulty with attention. Seizures were defined as clinical events with a high-degree of suspicion to be true seizures, and were entirely comprised of generalized tonic-clonic seizures. Conclusion Clinicians should suspect EEE in immunocompetent patients with early subcortical neuroimaging abnormalities and CSF neutrophilic predominance. This study suggests a lower mortality than previously reported, but a high morbidity rate in EEE. IVIG as an adjunctive to standard of care may be considered early during hospitalization. Disclosures All Authors: No reported disclosures

TREATMENT OF TEMPORAL LOBE EPILEPSY WITH SULTHIAME (“OSPOLOT”): A FOLLOW‐UP STUDY

1967 ◽  
Vol 2 (16) ◽  
pp. 729-731 ◽  
Author(s):  
P. Mann ◽  
T. Eckert ◽  
J. H. Tyrer ◽  
J. M. Sutherland
Keyword(s):  
Temporal Lobe Epilepsy ◽  
Temporal Lobe ◽  
Follow Up Study
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