We report a patient with juvenile myoclonic epilepsy who subsequently developed temporal lobe epilepsy, which gradually became clinically dominant. Video telemetry revealed both myoclonic seizures and temporal lobe seizures. The temporal lobe seizures were accompanied by a focal recruiting rhythm with rapid generalisation on EEG, in which the ictal EEG pattern during the secondary generalised phase was morphologically similar to the ictal pattern during myoclonic seizures. The secondary generalised seizures of the focal epilepsy responded to sodium valproate, similar to the myoclonic epilepsy. In this rare case of coexistent Juvenile Myoclonic Epilepsy and Temporal lobe epilepsy, the possibility of focal epilepsy recruiting a generalised epileptic network was proposed and discussed.
The study was conducted based on two objectives as framework. The first objective is to determine the point of microwave signal reflection while penetrating into the simulation models and, the second objective is to analyze the reflection pattern when the signal penetrate into the layers with different relative permittivity, εr. Thus, several microwave models were developed to make a close proximity of the in vivo human brain. The study proposed two different layers on two different characteristics models. The radii on the second layer and the corresponding antenna positions are the factors for both models. The radii for model 1 is 60 mm with an antenna position of 10 mm away, in contrast, model 2 is 10 mm larger in size with a closely adapted antenna without any gap. The layers of the models were developed with different combination of materials such as Oil, Sandy Soil, Brain, Glycerin and Water. Results show the combination of Glycerin + Brain and Brain + Sandy Soil are the best proximity of the in vivo human brain grey and white matter. The results could benefit subsequent studies for further enhancement and development of the models.
In the medical diagnosis and treatment planning, radiologists and surgeons rely heavily on the slices produced by medical imaging devices. Unfortunately, these image scanners could only present the 3-D human anatomical structure in 2-D. Traditionally, this requires medical professional concerned to study and analyze the 2-D images based on their expert experience. This is tedious, time consuming and prone to error; expecially when certain features are occluding the desired region of interest. Reconstruction procedures was earlier proposed to handle such situation. However, 3-D reconstruction system requires high performance computation and longer processing time. Integrating efficient reconstruction system into clinical procedures involves high resulting cost. Previously, brain's blood vessels reconstruction with MRA was achieved using SurLens Visualization System. However, adapting such system to other image modalities, applicable to the entire human anatomical structures, would be a meaningful contribution towards achieving a resourceful system for medical diagnosis and disease therapy. This paper attempts to adapt SurLens to possible visualisation of abnormalities in human anatomical structures using CT and MR images. The study was evaluated with brain MR images from the department of Surgery, University of North Carolina, United States and CT abdominal pelvic, from the Swedish National Infrastructure for Computing. The MR images contain around 109 datasets each of T1-FLASH, T2-Weighted, DTI and T1-MPRAGE. Significantly, visualization of human anatomical structure was achieved without prior segmentation. SurLens was adapted to visualize and display abnormalities, such as an indication of walderstrom's macroglobulinemia, stroke and penetrating brain injury in the human brain using Magentic Resonance (MR) images. Moreover, possible abnormalities in abdominal pelvic was also visualized using Computed Tomography (CT) slices. The study shows SurLens' functionality as a 3-D Multimodal Visualization System.
Highly-pathogenic avian influenza (HPAI) H5N1 and Newcastle disease (ND) viruses are the two most important poultry viruses in the world, with the ability to cause classic central nervous system dysfunction in poultry and migratory birds. To elucidate the mechanisms of neurovirulence caused by these viruses, a preliminary study was design to analyze host's cellular responses during infections of these viruses.
A 13-year-old girl with a known diagnosis of systemic lupus erythematosus presented with seizures and psychosis. An electroencephalogram (EEG) revealed continuous, non-evolving periodic lateralized epileptiform discharges (PLEDs) in the left temporal region, which did not resolve with benzodiazepine. A magnetic resonance imaging (MRI) brain scan demonstrated a focal hyperintensity in the left medial temporal and left occipital lobes, left thalamus and bilateral cerebellar white matter, with evidence of vasculitis in the magnetic resonance angiography. Intravenous immunoglobulin was given because of failed steroid therapy, which resulted in a full resolution of clinical, EEG and MRI abnormalities. Lupus cerebritis should be considered as a possible aetiology in PLEDs, and immunoglobulin can be effective in neuropsychiatric lupus.
Every body has to eat to survive but it becomes a matter of great concern, when the life provider food becomes an asphyxiating agent. In this case, a 60-year-old woman choked herself while swallowing biscuits. On autopsy examination, biscuits were found lodged in larygo-pharynx. Brain showed marked dystrophy and loosened lusterless white matter. On histopathologic examination, brain tissue had numerous eosinophilic globules representing astrocytic processes called "Rosenthal fibers"; hence, it was diagnosed as a case of Alexander dystrophy. It is a disease of white matter, where there is a progressive degeneration of the white matter of the brain because of imperfect growth or development of the myelin sheath. The histopathology of brain showed Rosenthal fibers in abundance. This is one of the rarest disease in which choking can occur because of lack of nervous and muscular coordination and weakness. Its specific relation to choking is documented in this report.
Ethylmalonic encephalopathy is a rare metabolic disease presenting in infancy with developmental delay, acrocyanosis, petechiae, chronic diarrhea and early death. The biochemical characteristics of this autosomal recessive disease are urinary organic acid abnormalities. Recently it has been found to be caused by mutations in the ETHE1 gene, located on Ch19q13. Only about 30 patients have been reported, and we describe two additional cases. The first patient showed a typical clinical picture and biochemical abnormalities, with additional atypical clinical features. Neuroimaging studies showed extensive changes. A new homozygous mutation in exon 3 of the ETHE1 gene was found. The second patient was not investigated genetically; however besides the typical clinical picture and biochemical profile he was found to have cytochrome C oxidase deficiency.
Magnetic resonance imaging (MRI) of the brain is the most important paraclinical diagnostic test in multiple sclerosis (MS). The appearance of MRI in Asians with MS is not well defined. We retrospectively surveyed the first brain and spinal cord MRI in patients diagnosed to have MS, according to Poser's criteria in seven regions throughout Asia to define the MRI changes among Asians with MS. There were 101 patients with first brain, and 86 with first spinal cord MRI, 66 of whom had both. The brain MRI showed a mean of 17 lesions per patient in T2 weighted images, mostly asymptomatic. Almost all the lesions were in the white matter, particularly in the juxtacortical, deep and periventricular white matter. A third of the lesions were greater than 5 mm, 14% enhanced with gadolinium. There were more supratentorial than infratentorial lesions at a ratio of 7.5: 1. Ninety five percent of the spinal cord lesions were in cervical and thoracic regions, 34% enhanced with gadolinium. The lesions extended over a mean of 3.6 +/- 3.3 vertebral bodies in length. Fifty (50%) of the brain and 54 (63%) of the spinal MRI patients had the optic-spinal form of MS. The MRI of the optic-spinal and classical groups of patients were similar in appearance and distribution, except that the optic-spinal MS patients have fewer brain but longer and more severe spinal cord lesions. In conclusion, the brain and spinal cord MRI of Asian patients with MS was similar to that of the West, although, in this study, Asian MS patients had larger spinal cord lesions.
CT and MRI scans are widely used in medical diagnosis procedures, but they only produce 2-D images. However, the human anatomical structure, the abnormalities, tumors, tissues and organs are in 3-D. 2-D images from these devices are difficult to interpret because they only show cross-sectional views of the human structure. Consequently, such circumstances require doctors to use their expert experiences in the interpretation of the possible location, size or shape of the abnormalities, even for large datasets of enormous amount of slices. Previously, the concept of reconstructing 2-D images to 3-D was introduced. However, such reconstruction model requires high performance computation, may either be time-consuming or costly. Furthermore, detecting the internal features of human anatomical structure, such as the imaging of the blood vessels, is still an open topic in the computer-aided diagnosis of disorders and pathologies. This paper proposes a volume visualization framework using Compute Unified Device Architecture (CUDA), augmenting the widely proven ray casting technique in terms of superior qualities of images but with slow speed. Considering the rapid development of technology in the medical community, our framework is implemented on Microsoft.NET environment for easy interoperability with other emerging revolutionary tools. The framework was evaluated with brain datasets from the department of Surgery, University of North Carolina, United States, containing around 109 MRA datasets. Uniquely, at a reasonably cheaper cost, our framework achieves immediate reconstruction and obvious mappings of the internal features of human brain, reliable enough for instantaneous locations of possible blockages in the brain blood vessels.
Brain oedema is thought to form and to clear through the use of water-protein channels, aquaporin-4 (AQP4), which are found in the astrocyte endfeet. The model developed here is used to study the function of AQP4 in the formation and elimination of oedema fluid in ischaemia-reperfusion injury. The cerebral space is assumed to be made of four fluid compartments: astrocyte, neuron, ECS and blood microvessels, and a solid matrix for the tissue, and this is modelled using multiple-network poroelastic theory. AQP4 allows the movement of water between astrocyte and the ECS and the microvessels. It is found that the presence of AQP4 may help in reducing vasogenic oedema shown by a decrease in brain tissue extracellular pressure. However, the astrocyte pressure will increase to compensate for this decrease, which may lead to cytotoxic oedema. In addition, the swelling will also depend on the ionic concentrations in the astrocyte and extracellular space, which may change after ischaemic stroke. Understanding the role of AQP4 in oedema may thus help the development of a treatment plan in reducing brain swelling after ischaemia-reperfusion.
Brain MRI segmentation is an important issue for discovering the brain structure and diagnosis of subtle anatomical changes in different brain diseases. However, due to several artifacts brain tissue segmentation remains a challenging task. The aim of this paper is to improve the automatic segmentation of brain into gray matter, white matter, and cerebrospinal fluid in magnetic resonance images (MRI). We proposed an automatic hybrid image segmentation method that integrates the modified statistical expectation-maximization (EM) method and the spatial information combined with support vector machine (SVM). The combined method has more accurate results than what can be achieved with its individual techniques that is demonstrated through experiments on both real data and simulated images. Experiments are carried out on both synthetic and real MRI. The results of proposed technique are evaluated against manual segmentation results and other methods based on real T1-weighted scans from Internet Brain Segmentation Repository (IBSR) and simulated images from BrainWeb. The Kappa index is calculated to assess the performance of the proposed framework relative to the ground truth and expert segmentations. The results demonstrate that the proposed combined method has satisfactory results on both simulated MRI and real brain datasets.
Work on the brain renin-angiotensin system has been explored by various researchers and has led to elucidation of its basic physiologies and behavior, including its role in reabsorption and uptake of body fluid, blood pressure maintenance with angiotensin II being its prominent effector. Currently, this system has been implicated for its newly established effects, which are far beyond its cardio-renal effects accounting for maintenance of cerebral blood flow and cerebroprotection, seizure, in the etiology of Alzheimer's disease, Parkinson's disease, multiple sclerosis, and bipolar disorder. In this review, we have discussed the distribution of angiotensin receptor subtypes in the central nervous system (CNS) together with enzymatic pathways leading to active angiotensin ligands and its interaction with angiotensin receptor 2 (AT2) and Mas receptors. Secondly, the use of angiotensin analogues (angiotensin converting enzyme inhibitors and AT1 and/or AT2 receptor blockers) in the treatment and management of the CNS disorders mentioned above has been discussed.
Boosting accuracy in automatically discriminating patients with Alzheimer's disease (AD) and normal controls (NC), based on multidimensional classification of longitudinal whole brain atrophy rates and their intermediate counterparts in analyzing magnetic resonance images (MRI).
A novel Hendra-like paramyxovirus named Nipah virus (NiV) was the cause of an outbreak among workers from one abattoir who had contact with pigs. Two patients had only respiratory symptoms, while 9 patients had encephalitis, 7 of whom are described in this report. Neurological involvement was diverse and multifocal, including aseptic meningitis, diffuse encephalitis, and focal brainstem involvement. Cerebellar signs were relatively common. Magnetic resonance imaging scans of the brain showed scattered lesions. IgM antibodies against Hendra virus (HeV) were present in the serum of all patients. Two patients recovered completely. Five had residual deficits 8 weeks later.
Over 100 viruses have been associated with acute central nervous system infections. The present review focuses on some of the most common agents of viral encephalitis, as well as important emerging viral encephalitides. In this context, the initial detection of West Nile virus in the Western Hemisphere during the 1999 New York City outbreak, the first description of Nipah virus in Malaysia, and the appearance in Asia of a new neurovirulent enterovirus 71 strain that causes severe neurologic disease are highlighted. In addition, advances regarding diagnosis, neuroimaging and treatment of Japanese and herpes simplex encephalitis are presented.
The Nipah virus outbreak represented one of several bat-derived paramyxoviruses that has emerged during the last decade to cause severe human and animal disease. The pathogenesis of Nipah infection is associated with its ability to infect blood vessels and extravascular parenchyma in many organs, particularly in the central nervous system. The clinical manifestations of acute Nipah infection range from fever and mild headache to a severe acute encephalitic syndrome in which there is a high mortality. Much remains to be understood about this new disease, including its intriguing ability to cause relapsing encephalitis in some survivors. This review provides an overview of the Nipah outbreak, focussing on what is presently known about it as an infectious disease, including the clinical aspects, pathology and pathogenesis.
The occurrence of a case of human rabies in Peninsular Malaysia is reported. Despite the various control measures taken, sporadic cases of rabies have continued to occur in Peninsular Malaysia, especially in the northern states. Clinical awareness of the occurrence of rabies is therefore important and effective post-exposure prophylaxis should be instituted as soon as possible to prevent the possible occurrence of this dreaded disease.
The aim of this work is to develop a Computer-Aided-Brain-Diagnosis (CABD) system that can determine if a brain scan shows signs of Alzheimer's disease. The method utilizes Magnetic Resonance Imaging (MRI) for classification with several feature extraction techniques. MRI is a non-invasive procedure, widely adopted in hospitals to examine cognitive abnormalities. Images are acquired using the T2 imaging sequence. The paradigm consists of a series of quantitative techniques: filtering, feature extraction, Student's t-test based feature selection, and k-Nearest Neighbor (KNN) based classification. Additionally, a comparative analysis is done by implementing other feature extraction procedures that are described in the literature. Our findings suggest that the Shearlet Transform (ST) feature extraction technique offers improved results for Alzheimer's diagnosis as compared to alternative methods. The proposed CABD tool with the ST + KNN technique provided accuracy of 94.54%, precision of 88.33%, sensitivity of 96.30% and specificity of 93.64%. Furthermore, this tool also offered an accuracy, precision, sensitivity and specificity of 98.48%, 100%, 96.97% and 100%, respectively, with the benchmark MRI database.