Comparative Study of Brain fMRI of Olfactory Stimulation in Neuromyelitis Optica Spectrum Disease and Multiple Sclerosis

Objective: To observe the characteristics of brain fMRI during olfactory stimulation in patients with neuromyelitis optica spectrum disease (NMOSD) and multiple sclerosis (MS), compare the differences of brain functional activation areas between patients with NMOSD and MS, and explore the characteristics of olfactory-related brain networks of NMOSD and MS.Methods: Nineteen patients with NMOSD and 16 patients with MS who met the diagnostic criteria were recruited, and 19 healthy controls matched by sex and age were recruited. The olfactory function of all participants was assessed using the visual analog scale (VAS). Olfactory stimulation was alternately performed using a volatile body (lavender and rose solution) and the difference in brain activation was evaluated by task-taste fMRI scanning simultaneously.Results: Activation intensity was weaker in the NMOSD group than in the healthy controls, including the left rectus, right superior temporal gyrus, and left cuneus. The activation intensity was stronger for the NMOSD than the controls in the left insula and left middle frontal gyrus (P < 0.05). Activation intensity was weaker in the MS group than the healthy controls in the bilateral hippocampus, right parahippocampal gyrus, right insula, left rectus gyrus, and right precentral gyrus, and stronger in the left paracentral lobule among the MS than the controls (P < 0.05). Compared with the MS group, activation intensity in the NMOSD group was weaker in the right superior temporal gyrus and left paracentral lobule, while it was stronger among the NMOSD group in the bilateral insula, bilateral hippocampus, bilateral parahippocampal gyrus, left inferior orbital gyrus, left superior temporal gyrus, left putamen, and left middle frontal gyrus (P < 0.05).Conclusion: Olfactory-related brain networks are altered in both patients, and there are differences between their olfactory-related brain networks. It may provide a new reference index for the clinical differentiation and disease evaluation of NMOSD and MS. Moreover, further studies are needed.

Study of Brain Structure and Function in Chronic Mountain Sickness Based on fMRI

Objective: Headache and memory impairment are the primary clinical symptoms of chronic mountain sickness (CMS). In this study, we used voxel-based morphometry (VBM) and the amplitude of the low-frequency fluctuation method (ALFF) based on blood oxygen level-dependent functional magnetic resonance imaging (BOLD-fMRI) to identify changes in the brain structure and function caused by CMS.Materials and Methods: T1W anatomical images and a resting-state functional MRI (fMRI) of the whole brain were performed in 24 patients diagnosed with CMS and 25 normal controls matched for age, sex, years of education, and living altitude. MRI images were acquired, followed by VBM and ALFF data analyses.Results: Compared with the control group, the CMS group had increased gray matter volume in the left cerebellum crus II area, left inferior temporal gyrus, right middle temporal gyrus, right insula, right caudate nucleus, and bilateral lentiform nucleus along with decreased gray matter volume in the left middle occipital gyrus and left middle temporal gyrus. White matter was decreased in the bilateral middle temporal gyrus and increased in the right Heschl's gyrus. Resting-state fMRI in patients with CMS showed increased spontaneous brain activity in the left supramarginal gyrus, left parahippocampal gyrus, and left middle temporal gyrus along with decreased spontaneous brain activity in the right cerebellum crus I area and right supplementary motor area.Conclusion: Patients with CMS had differences in gray and white matter volume and abnormal spontaneous brain activity in multiple brain regions compared to the controls. This suggests that long-term chronic hypoxia may induce changes in brain structure and function, resulting in CMS.

Endoscopic findings of dental implant found in the infundibulum showing the mucociliary clearance of the maxillary sinus

Significance statement: A 53-year-old man with left facial pain was referred to our hospital. Nasal endoscopy revealed a purulent discharge at the left middle meatus and bulging of the uncinate process. Computed tomography demonstrated that the dental implant was blocking the left maxillary ostium. Functional endoscopic sinus surgery was performed under general anesthesia. After removal of the uncinate process, a yellowish purulent discharge in the left maxillary sinus discharged from the maxillary sinus. The presence of the dental implant in the infundibulum shows the direction of mucociliary clearance from the nasal sinus. This case indicates how our sinus clears a foreign body, and the direction in which the foreign body is removed.

Microscopic Fractional Anisotropy Detects Cognitive Training-Induced Microstructural Brain Changes

Cognitive training-induced neuroplastic brain changes have been reported. This prospective study evaluated whether microscopic fractional anisotropy (μFA) derived from double diffusion encoding (DDE) MRI could detect brain changes following a 4 week cognitive training. Twenty-nine healthy volunteers were recruited and randomly assigned into the training (n = 21) and control (n = 8) groups. Both groups underwent brain MRI including DDE MRI and 3D-T1-weighted imaging twice at an interval of 4–6 weeks, during which the former underwent the training. The training consisted of hour-long dual N-back and attention network tasks conducted five days per week. Training and time-related changes of DDE MRI indices (μFA, fractional anisotropy (FA), and mean diffusivity (MD)) and the gray and white matter volume were evaluated using mixed-design analysis of variance. In addition, any significant imaging indices were tested for correlation with cognitive training-induced task performance changes, using partial correlation analyses. μFA in the left middle frontal gyrus decreased upon the training (53 voxels, uncorrected p < 0.001), which correlated moderately with response time changes in the orienting component of attention (r = −0.521, uncorrected p = 0.032). No significant training and time-related changes were observed for other imaging indices. Thus, μFA can become a sensitive index to detect cognitive training-induced neuroplastic changes.

Usefulness of Kaloderm® in Finger Tip Necrosis : A Case Report

We experienced a case of crush injury of the hand for which we performed a flap surgery and treated the necrotic parts placement using cultured allogeneic keratinocytes (Kaloderm^® ) with good results. The patient was a 31-year-old woman whose left middle finger was caught in a door, causing a crush injury. Although primary repair was performed, a 2 × 2.5-cm-sized necrosis developed, and a V-Y advancement flap was performed after the removal of dead tissues. However, a 1 × 2-cm-sized partial necrosis occurred and was treated using Kaloderm ^® . After the use of Kaloderm^® , the patient’s wound was healed, and no complications, except for mild pain, were observed for 1 year after the surgery. If a necrotic site appears after flap placement of fingertip, its treatment is difficult. If used well, Kaloderm^® may be a good option for necrosis of the fingertips and other areas that are difficult to cure.

Therapeutic Challenge in a Case of Recent Onset Refractory Cluster Seizures

A dilemma exists in context to the timing of surgery in a case presenting with explosive onset seizures secondary to a focal cortical dysplasia (FCD). This case report highlights the challenges faced in the management of a 4-year-old child with recent onset cluster seizures refractory to anti-epileptic drugs. A 4-year-old girl presented with an acute onset of cluster seizures (up to 32 in a day), semiologically characterized by tonic upper limb extension and laughter lasting for few seconds with no response to multiple anti-epileptic drugs. The clinical, electrographic, neuroimaging and interictal positron emission tomography data were concordant and consistent with a left middle frontal gyrus dysplasia which was successfully resected under electrocorticographic guidance. Patient is seizure free at 2 months of follow up. (Engel Class 1). Surgical resection is feasible and potentially more effective in the early phase of clinical presentation of FCD.

Unusual Intracranial Manifestation of Infective Endocarditis

Objective: The mycotic aneurysm is a rare intracranial pathology seen with pre-existing infective endocarditis. It has a high mortality rate due to its risk of rupture and needs early diagnosis and treatment. Methods: A 23-year male patient who presented with infective endocarditis subsequently developed a left parietal-temporal intracranial haemorrhage with suspicion of aneurysm after the course of antibiotic treatment as seen on Computed Tomography (CT) scan. Digital Subtraction Angiography (DSA) revealed a ruptured fusosaccular aneurysm in the distal parietal branches of the left Middle Cerebral Artery (MCA), for which glue embolization of the distal parent artery and aneurysm was done. Result: The interventional endovascular procedure was done with complete obliteration of the distal parent artery, mycotic aneurysm, and normal filling of the left internal cerebral artery (ICA) branches. Conclusion: Mycotic intracranial aneurysms (MIA) are a rare form of cerebrovascular pathology which needs early diagnosis with endovascular intervention when rupture occurs.

De novo aneurysm formation after the contralateral middle cerebral aneurysm clipping operation: a case report and review of literature

A left middle cerebral artery aneurysm was ruptured and clipped, but a de novo aneurysm on contralateral side ruptured within 5 years in a 38-year-old man. The cause of the formation of de novo aneurysms is unknown and is not consistent with most of current reports.

Pictograph Portrays What It Is

As one origin of Chinese characters, pictograph has a graphical structure based on its referent. Are the aesthetic qualities of the reference objects reflected in the neural processing of pictographs? In the study reviewed in this chapter, participants were scanned while making aesthetic judgments of pictographs and their referents. The conjunction analysis revealed the common involvement of the bilateral inferior occipital gyri and inferior frontal gyri, the right superior occipital gyrus, the left middle occipital gyrus, and the inferior orbitofrontal cortex for the aesthetic judgments of pictographs and object images referring to beautiful objects. Moreover, only the beautiful judgments for pictographs but not object images activated the motor areas, implying that an approach motivation was elicited during the aesthetic perception of novel pictographs. Results indicate that not only the object images, but also the corresponding pictographs arouse a sense of beauty that relies on common neural mechanisms during aesthetic judgments.

Brain structural and functional anomalies associated with simultanagnosia in patients with posterior cortical atrophy

Simultanagnosia is a common symptom of posterior cortical atrophy, and its association with brain structural and functional changes remains unclear. In our study, 18 posterior cortical atrophy patients with simultanagnosia, 29 patients with Alzheimer’s disease and 20 cognitively normal controls were recruited and subjected to full neuropsychological evaluation, including simultanagnosia tests, and structural and resting-state functional MRI. The gray matter volume was assessed by voxel-based morphometry, while the intrinsic functional connectivity was evaluated using the reduced gray matter volume regions of interest as the seed. In contrast to the patients with Alzheimer’s disease, those with posterior cortical atrophy showed the following: (1) markedly lower simultanagnosia test scores, (2) an altered regional gray matter volume of the left middle occipital gyrus and ventral occipital areas, and (3) lowered intrinsic functional connectivity with the left middle occipital gyrus, left lingual gyrus and right middle occipital gyrus separately. Additionally, the gray matter volume of the left middle occipital gyrus and left inferior occipital gyrus were each correlated with simultanagnosia in posterior cortical atrophy patients. The intrinsic functional connectivity of the left middle occipital gyrus with the right superior occipital gyrus and that of the right middle occipital gyrus with the left superior parietal gyrus were also correlated with simultanagnosia in posterior cortical atrophy patients. In summary, this study indicated that simultanagnosia is associated with gray matter reductions and decreased functional connectivity in the left middle occipital gyrus and the left inferior occipital gyrus in patients with posterior cortical atrophy.