Volume 03 · Issue 02 · 2017

Subependymal giant cell astrocytoma (SEGA) is a clinically benign brain tumor associated with tuberous sclerosis complex (TSC). There are still controversies on early diagnosis of the tumor.

CT and MR imaging of 20 patients with pathologically confirmed SEGA were retrospectively reviewed. Two radiologists evaluated the location, shape, size, number, edge, cerebral edema, homogeneous or heterogeneous appearance, attenuation and signal intensity, degree of enhancement and calcification of lesions. Their prognoses were based on clinical observations.

SEGA showed similar features in imaging: an extra-axial, well-circumscribed, periventricular mass, isodense or slightly hyperdense on CT, hypointensity on T1-weighted imaging and isointensity to hyperintensity on T2-weighted imaging. The mass enhanced markedly and heterogeneously after the administration of contrast agent. Subependymal nodules were demonstrated in 5 cases. Remarkably, 17 patients (85%) showed ventricular dilatation and 14 patients (70%) showed calcification in CT and MR imaging. Moreover, perifocal edema was not significantly near the masses. Four cases are associated with tuberous sclerosis complex (TSC).

Although there are no pathognomonic imaging findings for SEGA, the following clinical and imaging features might be helpful for the diagnosis, such as the initial age of first or second decade, typical location in the periventricular regions adjacent to the foramen of Monro, hydrocephalus accompanied with raised intracranial pressure, TSC and marked heterogeneous enhancement.

We aimed to evaluate the clinical presentations and report the acceptable clinical and angiographic outcome of the distal posterior cerebral artery (PCA) dissecting aneurysms with parent artery occlusion (PAO).

From June 2006 to July 2013, 26 patients with PCA dissecting aneurysms were planned to be treated via endovascular PAO in our institution. Fourteen patients had ruptured aneurysms, and twelve patients had unruptured aneurysms. The endovascular modalities were the following: 1) PAO (n = 19), 2) palliative embolization (n = 5), and 3) proximal PAO (n = 2). Glasgow Outcome Scale (GOS) was used to assess the clinical outcome.

The procedure was technically successful in all cases. In the PAO and proximal PAO group, all of the immediate angiography showed occlusion of the parent vessel, and follow-up imaging showed no recurrence of the aneurysms. In the palliative embolization group, one of five patients was died of rebleeding after the procedure, and follow-up digital subtraction angiography (DSA) showed the other four aneurysms recurred. Five procedure related complications occurred totally: rebleeding (n= 1), hemiparesis (n= 2), and hemianopsia (n= 2).

Dissecting aneurysms are dynamic lesions with variable and unpredictable evolution and a thorough treatment is warranted. Sacrificing the parent artery appears to be well tolerated for distal segment of PCA. We propose that this technique could be the first treatment option in treating dissecting aneurysms in this location. However, palliative occlusion of distal PCA dissecting aneurysms is not an advisable treatment option.

Pituitary stalk thickening (PST) used as an imaging diagnosis plays a major role in diagnosis and treatment of the hypothalamus and pituitary disease at an early stage. Up until now, several lines of systematic investigations have been conducted among adolescents, and the results indicated that PST is possibly one of the principal early manifestations of sellar region tumor. To characterize the major clinical features of PST and to identify the most effective treatments we conducted this study.

This was a retrospective review of patients with PST evaluated at Huashan Hospital over an eight-year period between 2007 and 2014. One hundred fifty nine patients who were diagnosed PST were included. The data including demographics, clinical presentations, imaging examinations, laboratory results and surgery were thoroughly reviewed and carefully analyzed. According to their clinical presentations and examinations, relevant treatments were adopted and different prognosis were observed.

Of the 159 patients, 57 were males and 102 were females (median age was 29 and 43.4% were under the age of 21 years). And of the patients in the age group between 30 and 35 years, 84% were females. "Polydipsia and polyuria" was the most common clinical manifestation observed in 90 cases (>50%). 49.5% of the patients were diagnosed to have at least one anterior pituitary dysfunction. The sellar region MRI (SR-MRI) data showed that patients who had different clinical presentations or pituitary function showed different SR-MRI appearance. Over 60% patients who performed follow-up MRI showed shrunken PST. Fourteen cases who received radiotherapy appeared to be improved as shown by MRI.

PST is most commonly seen in the teenagers and the women of reproductive age. Distinct etiology may be identified based on the clinical manifestations, age and SR-MRI, which would help to make the final decision for treatments. Radiotherapy and immuno-suppressed therapy are effective in alleviating clinical symptoms and shrinking the stalk thickening.

With the development of emergency and intensive medical technologies, the survival rate of traumatic brain injury has greatly increased. More and more patients have been converted from severe coma to alleviated state of consciousness, which can be subsequently classified within the framework of disorders of consciousness (DOC). We investigated the clinical application and characteristics of imaging indicators of diffusion tensor imaging (DTI) for the DOC patients.

DTI was performed on a total of 75 cases with a clinical diagnosis of DOC from January 2014 to December 2015 in Beijing Tiantan Hospital and PLA Army General Hospital (including 66 cases of unresponsive wakefulness state (UWS) patients and 9 cases of minimally conscious state (MCS) patients). The data for the imaging indicators, such as fractional anisotropy (FA) and mean diffusivity (MD), were separately collected from three relevant regions of interest (ROIs): brainstem, thalamus, and subcortex. The indicators of two groups with different conscious states were statistically analyzed, and correlation analyses were conducted for the mean values of FA and MD in the ROIs evaluated through clinical Coma Recovery Scale-Revised (CRS-R) scores.

The FA value of the UWS group was evidentially lower than that of the MCS group (P < 0.05), while the MD value of the UWS group was higher than that of the MCS group (P < 0.05); the difference was statistically significant. The FA and MD values in the ROIs (locations: brainstem, thalamus, and subcortex) correlated with CRS-R scores, particularly in the thalamus.

DTI has a certain clinical reference value for DOC imaging grading. The more severe the DOC, the higher the MD value and the lower the FA value.

Bioethics falls within the controversial ethical issues from the new advances and emerging technology in pre-clinical and clinical settings which inspired medical policy and practice. The purpose of this paper is to present an overview of ethical issues in stem cell-based therapies and to provide substantial argument for the need of a Bioethics Research Consortium that will be tasked with convening a disciplined board of experts that will apply their principles to biomedical research, and emerging technology to further stipulate the socioeconomic influence of such entities and their therapeutic impact to society. Not too long ago, the successful therapeutic studies in Parkinson’s disease and stroke were the highlights of bioethical issues. The precedent for study selection was based on public feedback, government reception, and scientific analyses developed by these spearhead studies. From all the negative publicity that researchers have been getting before, the whiplash from decades of fear and misunderstanding has hindered the progress of scientific study. There is a huge figurative tug of war between what is making profit and what is needed to improve the health of afflicted patients worldwide. Poor management of education and funding may have actually hindered potential life changing cures and treatments from coming to fruition. We propose the creation of a Bioethics Research Consortium that would determine how ethical matters are handled with careful consideration to public need. The goal is to restructure drug development policy, and improve upon the ways in which research methods and funds are handled today.

Here, we compiled ten papers detailing recent strides in the field of stem cell therapy, which address critical issues relevant to pursuing this experimental treatment for clinical applications in brain disorders. Topics include efficacy, safety, and mechanism of action underlying cell therapy, emerging technologies and combination pharmacotherapies with cell transplantation directed at improving the functional outcomes, and evaluation of key translational components of advancing novel therapeutics to the clinic, including the need for vis-à-vis comparisons with the gold standard of treatment post-injury (i.e., physical rehabilitation). A bioethics paper is also incorporated here to further appreciate the current status of cell therapy in the community setting. The overall goal of this special volume is to provoke a meaningful assessment of the lessons we have learned in recent years and to use such knowledge to carefully translate safe and effective applications of cell therapy, and its mechanism of action for the treatment of neurological disorders.

To investigate nonketotic hyperglycemia (NKH)-related epileptic clinical features and pathogenesis, and improve the diagnosis and treatment.

Clinical data, including the clinical manifestations, laboratory tests, imaging studies and other information, of 13 patients with hyperglycemia-related epilepsy in our department were retrospectively analyzed.

Blood glucose levels of the 13 patients when admitted to the hospital ranged between 24.7-34.6 mmol/L (average 28.3 mmol/L), their plasma osmolality ranged between 290–332 mOsm/L (average 308 mOsm/L), and their ketone results were negative. Among them, seven had convulsions, 4 had upper limbs and facial twitching, and 2 had bust twitch. Imaging findings could not detect accountable lesions related to seizures. EEG mainly showed spikes, slow waves, and scattered sharp slow waves. Insulin combined short-term antiepileptic drugs, allowed the epilepsy to be effectively controlled without recurrence.

Patients with episodes of NKH epilepsy increased significantly with hyperglycemia. Raising awareness of the disease, early diagnosis, and very early lowering the hyperglycemia levels, can effectively control the seizures. Lowering blood glucose is an effective way to control blood glucose levels.

Developmental venous anomaly (DVA), previously known as "venous angioma" , is the most common cerebral vascular malformation, but hemispheric DVA is extremely rare.

In this article we present a 21-year-old female with a large DVA draining the whole left hemisphere, combined with a vein of Galen varix and falcine sinus. To our knowledge, only 4 cases of hemispheric DVA have been reported before, however, none with a vein of Galen varix. This patient’s digital subtraction angiography also revealed double straight sinus with severe stenosis of one of the sinuses, which was considered to be the possible reason of the venous varix. The patient was managed conservatively, and her clinical status was stable for 1 year.

Because brain DVA drains the normal cerebral parenchyma and the hemorrhage risk is relatively low, hemispheric DVA is considered to be a benign anomaly, and conservative treatment is recommended.

Repeated intracranial hemorrhages caused by cardiac myxoma is very rare. It is essential for physicians to be aware of such uncommon clinical feature of myxoma.

We report a-49-year-old female patient complained of repeated multiple intracranial hemorrhages, with no sign of cardiac dysfunction or cerebral infarction before admission. Cavernous angioma (CA) was misdiagnosded due to the clinical and magnetic resonance (MR) presentation. A sudden ischemic event after admission led to the finding of a left atrial myxoma.

Repeated intracranial hemorrhages can be the early and primary clinical presentation of cardiac myxoma, probably caused by its metastasis, without obvious ischemic stroke or cardiac symptoms.

Parkinsonism-hyperpyrexia syndrome (PHS) is a rare but potentially fatal condition in patients with Parkinson’s disease. Deep brain stimulation (DBS) is a widely used and efficacious treatment for advanced Parkinson’s disease.

Here, we report a case of PHS in a patient who first underwent withdrawal of antiparkinsonian medications and then bilateral subthalamic nucleus DBS.

Patients should be advised to gradually decrease rather than suddenly stop antiparkinsonian medications when they must stop taking a medication and antiparkinsonian medications should be reintroduced as soon as possible after surgery.