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Fulltext Love as a Modulator of Pain

Tamam S, Ahmad AH

Malays J Med Sci, 2017 May;24(3):5-14.
PMID: 28814928 MyJurnal DOI: 10.21315/mjms2017.24.3.2

Pain is modulated by various factors, the most notable of which is emotions. Since love is an emotion, it can also modulate pain. The answer to the question of whether it enhances or reduces pain needs to be determined. A review was conducted of animal and human studies in which this enigmatic emotion and its interaction with pain was explored. Recent advances in neuroimaging have revealed similarities in brain activation relating to love and pain. At the simplest level, this interaction can be explained by the overlapping network structure in brain functional connectivity, although the explanation is considerably more complex. The effect of love can either result in increased or decreased pain perception. An explanation of the interaction between pain and love relates to the functional connectivity of the brain and to the psychological construct of the individual, as well as to his or her ability to engage resources relating to emotion regulation. In turn, this determines how a person relates to love and reacts to pain.

Matched MeSH terms: Neuroimaging
Fulltext Leigh syndrome: MRI findings in two children

Kartikasalwah A, Lh N

Biomed Imaging Interv J, 2010 Jan-Mar;6(1):e6.
PMID: 21611066 MyJurnal DOI: 10.2349/biij.6.1.e6

Leigh syndrome is a progressive neurodegenerative disorder of childhood. The symmetrical necrotic lesions in the basal ganglia and/or brainstem which appear as hyperintense lesions on T2-weighted MRI is characteristic and one of the essential diagnostic criteria. Recognising this MR imaging pattern in a child with neurological problems should prompt the clinician to investigate for Leigh syndrome. We present here two cases of Leigh syndrome due to different biochemical/genetic defects, and discuss the subtle differences in their MR neuroimaging features.

Matched MeSH terms: Neuroimaging
Fulltext Covert Cognition in Disorders of Consciousness: A Meta-Analysis

Schnakers C, Hirsch M, Noé E, Llorens R, Lejeune N, Veeramuthu V, et al.

Brain Sci, 2020 Dec 02;10(12).
PMID: 33276451 DOI: 10.3390/brainsci10120930

Covert cognition in patients with disorders of consciousness represents a real diagnostic conundrum for clinicians. In this meta-analysis, our main objective was to identify clinical and demographic variables that are more likely to be associated with responding to an active paradigm. Among 2018 citations found on PubMed, 60 observational studies were found relevant. Based on the QUADAS-2, 49 studies were considered. Data from 25 publications were extracted and included in the meta-analysis. Most of these studies used electrophysiology as well as counting tasks or mental imagery. According to our statistical analysis, patients clinically diagnosed as being in a vegetative state and in a minimally conscious state minus (MCS-) show similar likelihood in responding to active paradigm and responders are most likely suffering from a traumatic brain injury. In the future, multi-centric studies should be performed in order to increase sample size, with similar methodologies and include structural and functional neuroimaging in order to identify cerebral markers related to such a challenging diagnosis.

Matched MeSH terms: Functional Neuroimaging
An insight into the role of Artificial Intelligence in the early diagnosis of Alzheimer's disease

Verma RK, Pandey M, Chawla P, Choudhury H, Mayuren J, Bhattamisra SK, et al.

CNS Neurol Disord Drug Targets, 2021 May 11.
PMID: 33982657 DOI: 10.2174/1871527320666210512014505

BACKGROUND: The complication of Alzheimer's disease (AD) has made the development of its therapeutic a challenging task. Even after decades of research, we have achieved no more than a few years of symptomatic relief. The inability to diagnose the disease early is the foremost hurdle behind its treatment. Several studies have aimed to identify potential biomarkers that can be detected in body fluids (CSF, blood, urine, etc) or assessed by neuroimaging (i.e., PET and MRI). However, the clinical implementation of these biomarkers is incomplete as they cannot be validated.
METHOD: To overcome the limitation, the use of artificial intelligence along with technical tools has been extensively investigated for AD diagnosis. For developing a promising artificial intelligence strategy that can diagnose AD early, it is critical to supervise neuropsychological outcomes and imaging-based readouts with a proper clinical review.
CONCLUSION: Profound knowledge, a large data pool, and detailed investigations are required for the successful implementation of this tool. This review will enlighten various aspects of early diagnosis of AD using artificial intelligence.

Matched MeSH terms: Neuroimaging
Fulltext The Spetzler-Martin Grading System and management of patients with intracranial arteriovenous malformation in a tertiary referral hospital

Al-Edrus, S. A., Suhaimi, S. N., Noor Azman, A. R., Latif, A. Z., Sobri, M.

Malaysian Journal of Medicine and Health Sciences, 2010;6(1):91-99.
MyJurnal

Introduction: An arteriovenous malformation (AVM) is an abnormal collection of blood vessels in which arterial blood flows directly into the draining vein without the normal interposed capillaries. The Spetzler-Martin grading system has been widely accepted worldwide to estimate the pretreatment risks and predict the outcome of patients with intracranial AVM. In Malaysia, we still do not have the baseline data of this grading system. Methods: A total of 33 patients from a tertiary referral hospital diagnosed with intracranial AVM based on neuroimaging findings over a 4-year period were studied. Medical
records were traced and neuroimaging findings were analysed. The AVMs were graded according to the Spetzler-Martin grading system and Fisher’s exact test was used to assess statistical difference between the grades of the AVM and management plan for the patients. Results: Four patients were graded as Grade 1, 9 patients as Grade II, 10 patients as Grade III, 6 patients as Grade IV and 4 patients as Grade V. Ten patients were treated conservatively; six patients underwent surgery and embolisation respectively. Four patients underwent radiosurgery and a combination of embolisation while surgery and radiosurgery were given to 5 patients and 2 patients respectively. Statistically significant difference (p=0.016) was found between the Spetzler-Martin grading system and the management of intracranial AVMs. Conclusion: The management decision was not made based on the
grading of the AVMs. It is recommended that all AVM patients be routinely graded according to this system prior to treatment.

Matched MeSH terms: Neuroimaging
Fulltext Spontaneous Thrombosis of Dural Arteriovenous Malformation: A Case Report

Sobri M., Mezlina W.Z., Subramaniam, J.H.

International Medical Journal Malaysia, 2009;8(2):39-42.
MyJurnal

Dural arteriovenous malformation (DAVM) is relatively rare and defined as abnormal connections or shunts between the arterial and the venous side of vascular tree located within the dura mater. Spontaneous closures of DAVM are rare and have been scarcely reported. This case report will describe the neuroimaging findings and classification of DAVM. A 50 year old lady presented with headache. Neuroimaging showed prominent serpinginous flow-void structures, cerebral angiogram confirmed the presence of DAVM at the occipital region. She had defaulted treatment and follow-up for 3 years. On second admission, she had a cerebral angiogram which showed normal findings with no evidence of fistulas or malformation. She was discharged well. Causes of spontaneous closure of DAVM are discussed.

Matched MeSH terms: Neuroimaging
Fulltext Management of acute intracerebral haemorrhage - an update

Law ZK, Appleton JP, Bath PM, Sprigg N

Clin Med (Lond), 2017 Apr;17(2):166-172.
PMID: 28365631 DOI: 10.7861/clinmedicine.17-2-166

Managing acute intracerebral haemorrhage is a challenging task for physicians. Evidence shows that outcome can be improved with admission to an acute stroke unit and active care, including urgent reversal of anticoagulant effects and, potentially, intensive blood pressure reduction. Nevertheless, many management issues remain controversial, including the use of haemostatic therapy, selection of patients for neurosurgery and neurocritical care, the extent of investigations for underlying causes and the benefit versus risk of restarting antithrombotic therapy after an episode of intracerebral haemorrhage.

Matched MeSH terms: Neuroimaging
Fulltext Characteristic differences in neuroimaging and physical findings between non-accidental and accidental traumatic brain injury in young children. A local experience in general hospital of Kuala Lumpur

Hafiz MZ, Saffari MH

Med J Malaysia, 2011 Jun;66(2):95-100.
PMID: 22106685 MyJurnal

OBJECTIVE: The objective of this study is to identify the characteristic neuroimaging (namely brain CT) as well as physical findings found in young children with nonaccidental traumatic brain injury (TBI) and to compare them with accident cases of the similar age group, in order to study the specific features of the former group more precisely.
MATERIALS AND METHODS: A cross sectional study was done involving 92 children aged 3 years old and below who were admitted to the Kuala Lumpur Hospital with diagnosis of moderate to severe traumatic brain injury from period of June 2007 to September 2009. These children were categorized into non-accidental and accidental TBI and their physical examination data, brain computed tomography and skeletal surveys were done within one week from the date of admission were compared.
RESULTS: There was a male predominance in both non-accidental and accidental TBI groups with male-to-female ratio of 2:1 and 3:1 respectively. The majority of the non-accidental TBI cases presented with no definite history of trauma (52.2%) while most of the accidental TBI cases were caused by motor vehicle accidents (69.9%). Subdural haematomas appeared to be significantly the most common brain haematomas among the nonaccidental TBI as compared to the accidental group while extradural haematomas were only present in the accidental TBI group. Cerebral edema was also significantly more common in the non-accidental group. Signs of pre-existing brain injury, including cerebral atrophy and subdural hygroma/effusion were present in 23.9% and 19.6% respectively among children with non-accidental TBI and in none of the children with accidental TBI. None of the children in the non-accidental group diagnosed to have shear injury while 6 (13.0%) of the children in the accidental group was diagnosed with diffuse axonal injury. In our series, retinal haemorrhage was significantly more common in the non-accidental TBI group (93.5%) as opposed to only 4(8.7%) children noted to have retinal haemorrhage in the accidental group. Seizures also occurred significantly more often in children with non-accidental TBI. Depressed skull fractures were only found in the accidental TBI group (19.6%), while other types of skull fractures occur more or less similar in both groups. Bodily fractures were also more predominant among the accidental group of TBI. Bodily lacerations/abrasions were only found in the accidental group while findings of bodily bruises were quite equal in both groups.
KEY WORDS: Traumatic brain injury, Non-accidental head injury (NAI), Young children

Matched MeSH terms: Neuroimaging*
Fulltext Automatic Region-Based Brain Classification of MRI-T1 Data

Yazdani S, Yusof R, Karimian A, Mitsukira Y, Hematian A

PLoS One, 2016;11(4):e0151326.
PMID: 27096925 DOI: 10.1371/journal.pone.0151326

Image segmentation of medical images is a challenging problem with several still not totally solved issues, such as noise interference and image artifacts. Region-based and histogram-based segmentation methods have been widely used in image segmentation. Problems arise when we use these methods, such as the selection of a suitable threshold value for the histogram-based method and the over-segmentation followed by the time-consuming merge processing in the region-based algorithm. To provide an efficient approach that not only produce better results, but also maintain low computational complexity, a new region dividing based technique is developed for image segmentation, which combines the advantages of both regions-based and histogram-based methods. The proposed method is applied to the challenging applications: Gray matter (GM), White matter (WM) and cerebro-spinal fluid (CSF) segmentation in brain MR Images. The method is evaluated on both simulated and real data, and compared with other segmentation techniques. The obtained results have demonstrated its improved performance and robustness.

Matched MeSH terms: Neuroimaging/methods*
Characteristics of Perfusion Computed Tomography Imaging in Patients with Seizures Mimicking Acute Stroke

Khoo CS, Kim SE, Lee BI, Shin KJ, Ha SY, Park J, et al.

Eur Neurol, 2020;83(1):56-64.
PMID: 32320976 DOI: 10.1159/000506591

INTRODUCTION: Seizures as acute stroke mimics are a diagnostic challenge.
OBJECTIVE: The aim of the study was to characterize the perfusion patterns on perfusion computed tomography (PCT) in patients with seizures masquerading as acute stroke.
METHODS: We conducted a study on patients with acute seizures as stroke mimics. The inclusion criteria for this study were patients (1) initially presenting with stroke-like symptoms but finally diagnosed to have seizures and (2) with PCT performed within 72 h of seizures. The PCT of seizure patients (n = 27) was compared with that of revascularized stroke patients (n = 20) as the control group.
RESULTS: Among the 27 patients with seizures as stroke mimics, 70.4% (n = 19) showed characteristic PCT findings compared with the revascularized stroke patients, which were as follows: (1) multi-territorial cortical hyperperfusion {(73.7% [14/19] vs. 0% [0/20], p = 0.002), sensitivity of 73.7%, negative predictive value (NPV) of 80%}, (2) involvement of the ipsilateral thalamus {(57.9% [11/19] vs. 0% [0/20], p = 0.007), sensitivity of 57.9%, NPV of 71.4%}, and (3) reduced perfusion time {(84.2% [16/19] vs. 0% [0/20], p = 0.001), sensitivity of 84.2%, NPV of 87%}. These 3 findings had 100% specificity and positive predictive value in predicting patients with acute seizures in comparison with reperfused stroke patients. Older age was strongly associated with abnormal perfusion changes (p = 0.038), with a mean age of 66.8 ± 14.5 years versus 49.2 ± 27.4 years (in seizure patients with normal perfusion scan).
CONCLUSIONS: PCT is a reliable tool to differentiate acute seizures from acute stroke in the emergency setting.

Matched MeSH terms: Neuroimaging/methods*
Fulltext Gaussian smoothing and modified histogram normalization methods to improve neural-biomarker interpretations for dyslexia classification mechanism

Usman OL, Muniyandi RC, Omar K, Mohamad M

PLoS One, 2021;16(2):e0245579.
PMID: 33630876 DOI: 10.1371/journal.pone.0245579

Achieving biologically interpretable neural-biomarkers and features from neuroimaging datasets is a challenging task in an MRI-based dyslexia study. This challenge becomes more pronounced when the needed MRI datasets are collected from multiple heterogeneous sources with inconsistent scanner settings. This study presents a method of improving the biological interpretation of dyslexia's neural-biomarkers from MRI datasets sourced from publicly available open databases. The proposed system utilized a modified histogram normalization (MHN) method to improve dyslexia neural-biomarker interpretations by mapping the pixels' intensities of low-quality input neuroimages to range between the low-intensity region of interest (ROIlow) and high-intensity region of interest (ROIhigh) of the high-quality image. This was achieved after initial image smoothing using the Gaussian filter method with an isotropic kernel of size 4mm. The performance of the proposed smoothing and normalization methods was evaluated based on three image post-processing experiments: ROI segmentation, gray matter (GM) tissues volume estimations, and deep learning (DL) classifications using Computational Anatomy Toolbox (CAT12) and pre-trained models in a MATLAB working environment. The three experiments were preceded by some pre-processing tasks such as image resizing, labelling, patching, and non-rigid registration. Our results showed that the best smoothing was achieved at a scale value, σ = 1.25 with a 0.9% increment in the peak-signal-to-noise ratio (PSNR). Results from the three image post-processing experiments confirmed the efficacy of the proposed methods. Evidence emanating from our analysis showed that using the proposed MHN and Gaussian smoothing methods can improve comparability of image features and neural-biomarkers of dyslexia with a statistically significantly high disc similarity coefficient (DSC) index, low mean square error (MSE), and improved tissue volume estimations. After 10 repeated 10-fold cross-validation, the highest accuracy achieved by DL models is 94.7% at a 95% confidence interval (CI) level. Finally, our finding confirmed that the proposed MHN method significantly outperformed the normalization method of the state-of-the-art histogram matching.

Matched MeSH terms: Neuroimaging/methods*
Alzheimer's disease prediction algorithm based on de-correlation constraint and multi-modal feature interaction

Cheng J, Wang H, Wei S, Mei J, Liu F, Zhang G

Comput Biol Med, 2024 Mar;170:108000.
PMID: 38232453 DOI: 10.1016/j.compbiomed.2024.108000

Alzheimer's disease (AD) is a neurodegenerative disease characterized by various pathological changes. Utilizing multimodal data from Fluorodeoxyglucose positron emission tomography(FDG-PET) and Magnetic Resonance Imaging(MRI) of the brain can offer comprehensive information about the lesions from different perspectives and improve the accuracy of prediction. However, there are significant differences in the feature space of multimodal data. Commonly, the simple concatenation of multimodal features can cause the model to struggle in distinguishing and utilizing the complementary information between different modalities, thus affecting the accuracy of predictions. Therefore, we propose an AD prediction model based on de-correlation constraint and multi-modal feature interaction. This model consists of the following three parts: (1) The feature extractor employs residual connections and attention mechanisms to capture distinctive lesion features from FDG-PET and MRI data within their respective modalities. (2) The de-correlation constraint function enhances the model's capacity to extract complementary information from different modalities by reducing the feature similarity between them. (3) The mutual attention feature fusion module interacts with the features within and between modalities to enhance the modal-specific features and adaptively adjust the weights of these features based on information from other modalities. The experimental results on ADNI database demonstrate that the proposed model achieves a prediction accuracy of 86.79% for AD, MCI and NC, which is higher than the existing multi-modal AD prediction models.

Matched MeSH terms: Neuroimaging/methods
Stroke in pregnancy

Liew BS, Ghani AA, You X

Med J Malaysia, 2019 Jun;74(3):246-249.
PMID: 31256185

Stroke is uncommon among young adults. However, the incidence of stroke among young women increases with pregnancy during peripartum and postpartum periods. The relative risk of suffering from haemorrhagic stroke was three times higher than ischemic stroke during these periods when compared with antenatal period. Neuroimaging should be prioritized in order to establish diagnosis and to facilitate treatment in a patient with suspected acute stroke. Prophylaxic anticoagulants should be used in high risk patients. Treatments of acute stroke in pregnant women include anti-platelet and thrombolytic agents. Further studies should be carried as there is lack of high level of evidences to formulate clear guideline for the management of stroke during pregnancy.

Matched MeSH terms: Neuroimaging
A case of probable sporadic Creutzfeldt-Jacob Disease in a tertiary care hospital in Malaysia

Mugilan SR, Joseph JP

Med J Malaysia, 2018 12;73(6):433-435.
PMID: 30647225

The diagnosis of Creutzfeldt-Jakob disease (CJD) can be challenging as findings are non-specific and there is low awareness of the disease. We present a case of an 83-yearold man with a two months history of rapidly progressive dementia. After a series of extensive diagnostic examinations, he was diagnosed with probable sporadic CJD with key findings of rapidly progressive dementia, myoclonus, pyramidal signs, abnormal hyperintensity signals on diffusion-weighted magnetic resonance imaging (DW-MRI) and typical electroencephalograph (EEG). His symptoms progressively worsened and he died four months after the onset of symptoms.

Matched MeSH terms: Neuroimaging
Fulltext Acute necrotizing encephalopathy of childhood: a severe case with fatal outcome

Yee Lin Lee, Hasyma Abu Hassan, Intan Hakimah Ismail

Malaysian Journal of Medicine and Health Sciences, 2020;16(2):323-325.
MyJurnal

Acute necrotizing encephalopathy of childhood (ANEC) is a rare condition which is important for clinicians to recognize as it has a high mortality rate and can result in significant neurological morbidities. It presents as acute encephalopathy with radiological findings of symmetrical brain lesions in bilateral thalami, putamen, brain stem teg- mentum, internal capsule, periventricular white matter and cerebellar medulla. Intravenous methylprednisolone is the mainstay of treatment. Immunoglobulin therapy and therapeutic hypothermia may be used as adjunctive therapy in cases with severe clinical and neuroradiological presentation. We present a case of severe ANEC and discuss the clinical manifestations, neuroimaging and management options.

Matched MeSH terms: Neuroimaging
Fibrinogen isoforms as potential blood-based biomarkers of Alzheimer's disease using a proteomics approach

Rehiman SH, Lim SM, Lim FT, Chin AV, Tan MP, Kamaruzzaman SB, et al.

Int J Neurosci, 2020 Dec 15.
PMID: 33280461 DOI: 10.1080/00207454.2020.1860038

Objective: Alzheimer's disease (AD), the commonest form of dementia which is characterized by progressive decline in cognitive function, can only be definitively diagnosed after death. Although biomarkers may aid diagnosis, currently available AD biomarkers, which are predominantly based on cerebrospinal fluid and neuroimaging facilities, are either invasive or costly. Blood-based biomarkers for AD diagnosis are highly sought after due to its practicality at the clinic. This study was undertaken to determine the differential protein expression in plasma amongst Malaysian AD, mild cognitive impairment (MCI) and non-AD individuals. Methods: A proteomic approach which utilized two-dimensional differential in gel electrophoresis (2 D DIGE) was performed for blood samples from 15 AD, 14 MCI and 15 non-AD individuals. Results: Mass spectrometry (MS)-based protein identification via MALDI ToF/ToF showed that fibrinogen-β-chain (spot 64) and fibrinogen-γ-chain (spot 91) with differential expression ratio >1.5 were significantly upregulated (p

Matched MeSH terms: Neuroimaging
Fulltext Surgical remotion of a cysticercotic granuloma responsible for refractory seizures: A case report

Hasan MS, Basri HB, Hin LP, Stanslas J

Surg Neurol Int, 2011;2:177.
PMID: 22276232 DOI: 10.4103/2152-7806.90698

BACKGROUND: Neurocysticercosis is the most common parasitic infestation of the central nervous system and an important cause of acquired epilepsy. Although endemic in developing countries, with an increased immigration from the endemic regions, it is also seen progressively in other parts of the world. Hence, there is an increased need for awareness of neurocysticercosis in the non-endemic areas.
CASE DESCRIPTION: The case described here is of a 13-year-old girl who presented with refractory seizures. She had been on antiepileptic medication and had also received anti-parasitic treatment for neurocysticercosis. Surgical intervention was recommended because the seizures were resistant to treatment and also because the diagnosis could not be clearly established. Following surgery, the seizures have been under control and the patient has been doing well.
CONCLUSION: Neurocysticercosis can be a potential cause of refractory seizure even in non-endemic countries. Some cases may be difficult to diagnose. Clinical presentation of seizure and brain imaging should be given priority over blood investigations for diagnosing neurocysticercosis and advanced neurosurgical intervention can be considered in suitable cases for better outcome.

Matched MeSH terms: Neuroimaging
Fulltext Diffusion tensor imaging of Leukoaraiosis, normal appearing brain tissue, and normal brain tissue

Nur Hartini Mohd Taib, Wan Ahmad Kamil Wan Abdullah, Ibrahim Lutfi Shuaib

Malaysian Journal of Medicine and Health Sciences, 2015;11(1):1-10.
MyJurnal

Diffusion Tensor Imaging (DTI) is an advanced magnetic resonance imaging (MRI) technique. DTI provides quantitative information at microstuructural level via its parameter indices e.g. mean diffusivity (MD) and fractional anisotropy (FA). It also allows for visualization of neuron fibres through a specific technique called fibre tractography. Leukoaraiosis is an asymptomatic pathological condition of the brain white matter which appears hyperintense on T2-weighted MRI images. Association of leukoaraiosis with age and ischemic heart disease have been previously reported. The objective of this study is to compare MD and FA values measured in various areas of the brain white matter (WM), grey matter (GM), and cerebrospinal fluid (CSF) in humans using DTI. 30 subjects with leukoaraiosis and 12 subjects without leukoaraiosis underwent brain scan using GE 1.5 Tesla MRI system. Region of interests were located in the CSF and various WM and GM areas. Comparison of MD and FA values was made between leukoaraiosis tissue (LA) and normal appearing brain tissue (NABT) measured within the same leukoaraiosis subjects, and with normal brain tissue (CONTROL) of healthy control subjects. LA demonstrated a significantly higher MD and lower FA compared to NABT and CONTROL in frontal and occipital WM areas. No differences were observed in MD in any brain region between NABT and CONTROL. Whereas no differences were observed in FA between NABT and CONTROL except in the occipital WM. Fibre tractography showed 31.7% to 56.1% lesser fibre tracts in LA subjects compared to CONTROL subjects. Significant differences were found between pathological tissue compared to normal appearing brain tissue and normal brain tissue. Fibre tractography exposed reduced number of neural fibres in leukoaraiosis subjects as compared to normal subjects.

Matched MeSH terms: Neuroimaging
Fulltext Spinal tuberculous disease is common in tuberculous meningitis

Tai, Sharon Mei-Ling, Hazman Mohd Nor, Kartini Rahmat, Pow, Zhen Yuan, Ong, Lay Sim, Tan, Chong Tin, et al.

Neurology Asia, 2017;22(4):313-323.
MyJurnal

Background: Tuberculous disease of spine (spinal TB) is under-recognized in tuberculous (TB) meningitis.
The objective of the study was to evaluate the frequency, clinical and neuroimaging changes, and
outcome in the patients with spinal TB.

Methods: All the patients with spinal TB admitted in the two
largest tertiary hospitals in Kuala Lumpur from 2009 to 2017 were recruited, the clinical features were
documented, the magnetic resonance imaging (MRI) of the spine was performed. Clinical outcome was
assessed with Modified Rankin scale (MRS).

Results: Twenty two patients were recruited. This was
out of 70 TB meningitis patients (31.4%) seen over the same period. Eighteen (81.8%) patients had
concomitant TB meningitis. The clinical features consisted of systemic symptoms with fever (63.6%),
meningitis symptoms with altered sensorium (45.5%), myelopathy with paraparesis (36.4%). The
findings on spinal MRI were discitis (36.4%), spinal meningeal enhancement (31.8%), spinal cord
compression (31.8%), psoas abscess (27.3%), osteomyelitis (22.7%), and cord oedema (22.7%). All
except two patients (90.9%) had involvement in psoas muscle, bone or leptomeningeal enhancement,
features that can be used to differentiate from myelopathy that affect the parenchyma only, such as
demyelination. Unusual manifestations were syringomyelia and paradoxical manifestations seen in 3
patients each. The outcome were overall poor, with 68% having MRS 3 or more.

Conclusion: Spinal TB is common in TB meningitis. The outcome is overall poor. A heightened
awareness is crucial to enable early diagnosis and treatment.

Matched MeSH terms: Neuroimaging
Fulltext Neural oscillation, network, eloquent cortex and epileptogenic zone revealed by magnetoencephalography and awake craniotomy

Idris Z, Kandasamy R, Reza F, Abdullah JM

Asian J Neurosurg, 2014 Jul-Sep;9(3):144-52.
PMID: 25685205 DOI: 10.4103/1793-5482.142734

BACKGROUND: Magnetoencephalography (MEG) is a method of functional neuroimaging. The concomitant use of MEG and electrocorticography has been found to be useful in elucidating neural oscillation and network, and to localize epileptogenic zone and functional cortex. We describe our early experience using MEG in neurosurgical patients, emphasizing on its impact on patient management as well as the enrichment of our knowledge in neurosciences.
MATERIALS AND METHODS: A total of 10 subjects were included; five patients had intraaxial tumors, one with an extraaxial tumor and brain compression, two with arteriovenous malformations, one with cerebral peduncle hemorrhage and one with sensorimotor cortical dysplasia. All patients underwent evoked and spontaneous MEG recordings. MEG data was processed at band-pass filtering frequency of between 0.1 and 300 Hz with a sampling rate of 1 kHz. MEG source localization was performed using either overdetermined equivalent current dipoles or underdetermined inversed solution. Neuromag collection of events software was used to study brain network and epileptogenic zone. The studied data were analyzed for neural oscillation in three patients; brain network and clinical manifestation in five patients; and for the location of epileptogenic zone and eloquent cortex in two patients.
RESULTS: We elucidated neural oscillation in three patients. One demonstrated oscillatory phenomenon on stimulation of the motor-cortex during awake surgery, and two had improvement in neural oscillatory parameters after surgery. Brain networks corresponding to clinico-anatomical relationships were depicted in five patients, and two networks were illustrated here. Finally, we demonstrated epilepsy cases in which MEG data was found to be useful in localizing the epileptogenic zones and functional cortices.
CONCLUSION: The application of MEG while enhancing our knowledge in neurosciences also has a useful role in epilepsy and awake surgery.
KEYWORDS: Awake craniotomy; brain network; epilepsy; magnetoencephalography; neural oscillation

Matched MeSH terms: Functional Neuroimaging

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