M. Maffei

SEEKING and depression in stroke patients: An exploratory study

The concept of SEEKING describes a predisposition to search enthusiastically for rewards in the environment. While SEEKING and its underlying functional anatomy have been extensively investigated in animals, such processes in humans, especially brain-damaged individuals, remain understudied. We therefore conducted an exploratory behavioral study in stroke patients to investigate the effects of brain lesions that anatomically could be interpreted to impact the SEEKING system and predicted relationships to depression. Patients with lesions in anterior, medial, and/or subcortical lesions showed significantly lower SEEKING scores and higher depression scores than nonlesioned subjects in the control group. Based on our data and related work on animals, we propose central involvement of the anterior subcortical–cortical midline system as core of the limbic system in SEEKING in humans.

Cerebellar Mutism after Medulloblastoma Resection: Importance of MR Features

We describe the MR features which appeared after resection of a medulloblastoma in the posterior fossa in a boy who developed postoperative cerebellar mutism. The anatomical and physiopathological factors responsible for this disorder are discussed.

FMRI activation with an "affective speech" paradigm in vegetative and minimally conscious States: applicability and prognostic value.

Vegetative state (VS) and minimally conscious state (MCS) are considered different clinical entities but their differential diagnosis remains challenging. Some VS patients can show an MCS-like activation in functional magnetic resonance imaging (fMRI) studies that seems to predict recovery from VS. We studied fMRI activation with an affective speech paradigm in a cohort of non-communicative brain-injured individuals consecutively admitted to a post-acute neurorehabilitation facility in five years. Among 93 eligible subjects, 65 met the clinical criteria for VS and 28 for MCS. Because of exclusion criteria, activation studies were performed in only 30 cases out of 93 and analysed in only 24 (about 1/4 of the eligible cases): 19 VS and five MCS patients. The passive acoustic stimulus consisted in a familiar voice narrating a significant episode in the patients life, administered by nonmagnetic earphones. All the MCS patients showed an activation spread to secondary associative cortices but also 52.7% of the VS patients displayed an “atypical” large-scale activation pattern. Regarding the clinical outcome, 80% of the patients with large-scale network activation (LSNA) had some recovery of consciousness. Our results confirm that the VS patients with LSNA at fMRI study have potential for further recovery of consciousness, whereas no patient without activation or only typical activation improved. fMRI study with an affective speech paradigm, when applicable, seems to have a valuable prognostic value in VS patients, even if there are major limitations in terms of applicability.

Do brain lesions in stroke affect basic emotions and attachment

The aim of the current study was to investigate basic emotions and attachment in a sample of 86 stroke patients. We included a control group of 115 orthopedic patients (matched for age and cognitive status) without brain lesions to control for unspecific general illness effects of a traumatic recent event on basic emotions and attachment. In order to measure basic emotions and attachment style we applied the Affective Neuroscience Personality Scale (ANPS) and the Attachment Style Questionnaire (ASQ). The stroke patients showed significantly different scores in the SEEKING, SADNESS, and ANGER subscales of the ANPS as well as in the Relationship as Secondary Attachment dimension of the ASQ when compared to the control group. These differences show a pattern influenced by lesion location mainly as concerns basic emotions. Anterior, medial, left, and subcortical patients provide scores significantly lower in ANPS-SEEKING than the control group; ANPS-SADNESS scores in anterior, right, medial, and subcortical patients were significantly higher than those of the control group. ANPS-ANGER scores in posterior, right, and lateral patients were significantly higher than those in the control group; finally, the ANPS-FEAR showed slightly lower scores in posterior patients than in the control group. Minor effects on brain lesions were also individuated in the attachment style. Anterior lesion patients showed a significantly higher average score in the ASQ-Need for Approval subscale than the control group. ASQ-Confidence subscale scores differed significantly in stroke patients with lesions in medial brain regions when compared to control subjects. Scores at ANPS and ASQ subscales appear significantly more correlated in stroke patients than in the control group. Such finding of abnormalities, especially concerning basic emotions in stroke brain-lesioned patients, indicates that the effect of brain lesions may enhance the interrelation between basic emotions and attachment with respect to the control group.

Metabolite Changes in Normal Appearing Cervical Spinal Cord in Two Patients with Multiple Sclerosis. A Proton MR Spectroscopic Analysis.

We describe two cases of multiple sclerosis (MS) analyzed with Proton MR Spectroscopy (1H-MRS) with the voxel placed along the main axis of the normal appearing cervical spinal cord over three main space planes, orthogonally set. Relative concentrations expressed by the absolute concentration ratios of total NAA (tNAA), choline (Cho), myo-inositol (mI) and creatine plus phosphocreatine (Cr) were compared with the metabolites of ten healthy volunteers. We found a significant increase in mI/Cr and a small increase in Cho/Cr in the first patient, whereas the second patient had a decrease in NAA/Cr and NAA/Cho ratios. 1H-MRS will disclose biochemical changes in MS, even in normal appearing spinal cord, as already described in normal appearing cerebral tissue: these biochemical changes may provide significant information on disease prognosis.

Superficial siderosis associated with peripheral autonomic failure and tetraventricular hydrocephalus: a case report

We describe the case of a man whose initial clinical presentation included sensorineural hearing loss and orthostatic hypotension. The patient was diagnosed with superficial siderosis associated with peripheral autonomic failure and tetraventricular hydrocephalus.

CT Diagnosis of Cerebral Venous Thrombosis: Importance of the First Examination for Fast Treatment.

This study is a retrospective investigation of the role of non contrast-enhanced CT (NCCT) in the diagnosis of cerebral venous thrombosis (CVT) in clinical practice. We retrospectively identified 24 patients discharged with a diagnosis of CVT between January 2002 and December 2008 who had undergone NCCT as the first imaging modality. NCCT had been evaluated by a general radiologist and subsequently by a neuroradiologist in five cases. Final diagnosis was established by CT angiography (CTA), magnetic resonance (MR) and digital subtraction angiography (DSA). NCCT diagnosis was defined as “positive” when the neuroradiologist suggested the diagnosis of CVT on the report, as opposed to the “negative” diagnosis group. All NCCT examinations were reviewed by a neuroradiologist experienced in cerebrovascular pathology. We compared his evaluation and analysed the location and number of direct signs found on NCCT. The neuroradiologist strongly suggested an NCCT diagnosis of CVT in 63% (15/24) of patients: 80% (4/5) with deep venous thrombosis (DVT) and 57% (11/19) with sinus venous thrombosis (SVT). The general radiologists NCCT evaluation was incorrect in four cases, subsequently diagnosed at NCCT by the neuroradiologist. After reviewing the NCCT examination the experienced neuroradiologist identified the CVT direct sign in two that belonged to the NCCT negative diagnosis group. Thus the direct sign was present in 71% (17/24) of the cases: all the patients with DVT and 63% (12/19) of the patients with SVT. NCCT still plays an important role for fast and accurate diagnosis of CVT in the emergency setting. NCCT displayed the CVT direct sign more frequently than previously thought and it was correctly interpreted in most cases. Neuroradiological consultation adds value to the general radiologists evaluation.

3 T MR Assessment of Pituitary Microadenomas A Report of Six Cases

Demonstration and accurate localisation of pituitary microadenomas in the adenohypophysis are essential to institute appropriate medical management and aid surgical planning, especially when an endoscopic procedure is envisaged. Given the features of pituitary microadenomas, ideally, high spatial and temporal resolution is required for neuroradiological investigation. There is a consensus in the literature that MR scanning is the method of choice for pituitary imaging and dynamic studies offer greater sensitivity in identifying pituitary microadenomas. However, the spatial resolution and limited number of slices acquired constitute major drawbacks using 1.5 T MR devices. A 3 Tesla Signa Excite MR system (GE Medical Systems) was recently installed in the Neuroradiology Unit of Bellaria Hospital, Bologna. The new device was tested specifically for the study of pituitary microadenomas using an FSE dynamic sequence allowing the acquisition of nine slices (slice thickness 2.5 mm) over the pituitary gland with high spatial resolution in a few seconds. This sequence, repeated six times after gadolinium administration through an injector, displays the gradual enhancement of the adenohypophysis and any microadenomas present in the gland. As the microadenoma uptake of gadolinium is lower than the adenohypophysis uptake, the possible microadenoma presence becomes appreciable only in some of the six sequences as a negative image with respect to the normal parenchyma. Pituitary microadenomas undetected in previous scans using a 1.5 T system were disclosed by this imaging technique with highly accurate morphological localisation.

Polymicrogyria, Large Corpus Callosum and Psychomotor Retardation in Four-Year-Old Girl: Potential Association Based on MR Findings A Case Report and Literature Review

We describe a child from consanguineous parents presenting mega corpus callosum (MegaCC), polymicrogyria, psychomotor retardation with swallowing difficulties and language impairment perhaps linked to the syndrome of megalencephaly-polymicrogyria-mega corpus callosum (MEG-PMG-MegaCC). Reviewing the literature, we speculate that MegaCC, psychomotor retardation and anomalies in cortical migration are the three pathognomonic features. The presence of additional possibly associated anomalies such as megalencephaly, indicates that the spectrum of linked malformations with this rare syndrome is broad and yet to be defined.

An ischaemic thalamic lesion extending to the mammillothalamic tract associated with absent ipsilateral mammillary body in a patient with temporal lobe epilepsy. A case report.

We describe a patient with right temporal lobe epilepsy with MR findings of an ischaemic thalamic lesion extending to the mammillothalamic tract and absent visualization of the mammillary body without signal changes in the hippocampus.