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Pediatric Radiology Dec 2020Fetal MRI is the modality of choice to study supratentorial brain malformations. To accurately interpret the MRI, the radiologist needs to understand the normal sequence... (Review)
Review
Fetal MRI is the modality of choice to study supratentorial brain malformations. To accurately interpret the MRI, the radiologist needs to understand the normal sequence of events that occurs during prenatal brain development; this includes familiarity with the processes of hemispheric cleavage, formation of interhemispheric commissures, neuro-glial proliferation and migration, and cortical folding. Disruption of these processes results in malformations observed on fetal MRI including holoprosencephaly, callosal agenesis, heterotopic gray matter, lissencephaly and other malformations of cortical development (focal cortical dysplasia, polymicrogyria). The radiologist should also be familiar with findings that have high association with specific conditions affecting the central nervous system or other organ systems. This review summarizes and illustrates common patterns of supratentorial brain malformations and emphasizes aspects that are important to patient care.
Topics: Brain; Female; Fetus; Gray Matter; Humans; Magnetic Resonance Imaging; Magnetic Resonance Spectroscopy; Malformations of Cortical Development; Nervous System Malformations; Pregnancy
PubMed: 33252760
DOI: 10.1007/s00247-020-04696-z -
Japanese Journal of Radiology Dec 2023Fetal MRI is performed to evaluate the brain in cases where an abnormality is detected by ultrasonography (US). Fetal MRI has higher contrast resolution than US. Because... (Review)
Review
Fetal MRI is performed to evaluate the brain in cases where an abnormality is detected by ultrasonography (US). Fetal MRI has higher contrast resolution than US. Because the fetal brain is dynamic structure, it is important to know the normal appearance of the brain at different gestational age to be better able to identify abnormalities using MRI. Fast imaging sequences to minimize artifact from fetal motion are required. The main sequences used are ultrafast T2 weighted imaging. Similar to pediatric neuroimaging, images are acquired in the axial, sagittal, and coronal planes. T1 weighted image and Gradient echo-planar T2 weighted images are performed to detect hemorrhage. Ventriculomegaly is the most common central nervous system abnormality identified on US. The causes of ventriculomegaly are very heterogeneous and include developmental, destructive, and obstructive processes, or a combination thereof. MRI improves diagnostic accuracy and can be used to evaluate the etiology of the ventriculomegaly. Moreover, MRI can play an important role in detecting additional findings, which may help to focus on patient counseling and management. This review summarizes and illustrates common pattern of ventriculomegaly due to mainly supratentorial abnormalities.
Topics: Pregnancy; Female; Humans; Child; Prenatal Diagnosis; Brain; Hydrocephalus; Magnetic Resonance Imaging; Nervous System Malformations
PubMed: 37493877
DOI: 10.1007/s11604-023-01462-7 -
Neurology India 2020CSF drainage from the ventricular system is a popular and effective technique for intraoperative brain relaxation as it reduces ICP, enlarges extra-axial operative...
BACKGROUND
CSF drainage from the ventricular system is a popular and effective technique for intraoperative brain relaxation as it reduces ICP, enlarges extra-axial operative corridors, and slackens the brain increasing its tolerance for surgical manipulation. However, sometimes when the ventricular chambers distant from the site of pathology are tapped, there is a risk of neurological worsening due to paradoxical herniation of the brain, exemplified by the phenomenon of upward transtentorial herniation observed in posterior fossa tumors, consequent to a supratentorial ventriculostomy. Expectation of an analogous phenomenon precludes contralateral ventricular drainage in supratentorial brain tumors producing midline shift, subfalcine herniation, and resultant distension of the opposite lateral ventricles.
OBJECTIVE
Demonstrating the safety and efficacy of intraoperative contralateral ventricular drainage in the presence of sub-falcine herniation.
METHODS
Clinical and imaging information were retrospectively collected for four cases in which this technique was adopted.
RESULTS
The first case was a large clinoidal meningioma with a midline shift and contralateral ventriculomegaly. EVD from the dilated ventricle provided optimum brain conditions for safe resection of the tumor through an orbitopterional approach. The second case required a contralateral EVD to reduce ICP intraoperatively, for a recurrent anaplastic ependymoma with severe mass effect. It reduced the venous hypertension related to raised ICP minimizing the blood loss. Contralateral EVD was utilized to enlarge the working corridor for interhemispheric approach in two cases.
CONCLUSION
Contralateral ventricular drainage is a safe, effective, and convenient operative step for reducing brain turgor in the presence of sub-falcine herniation produced by large supratentorial tumors.
Topics: Brain; Cerebral Ventricles; Female; Humans; Hydrocephalus; Infratentorial Neoplasms; Lateral Ventricles; Male; Middle Aged; Neoplasm Recurrence, Local; Supratentorial Neoplasms; Ventriculostomy
PubMed: 32129267
DOI: 10.4103/0028-3886.279710 -
Neuroimaging Clinics of North America Feb 2017The breadth of tumors that can arise in the supratentorial brain in children is extensive. With the exception of those that result in seizures and the highly malignant... (Review)
Review
The breadth of tumors that can arise in the supratentorial brain in children is extensive. With the exception of those that result in seizures and the highly malignant histologies, supratentorial tumors may come to medical attention later compared with infratentorial tumors, as they are less commonly associated with ventricular obstruction. This article presents an overview of the neuroimaging characteristics of these entities, with particular attention to relevant features that may aid in narrowing the differential diagnosis, including correlation with demographics and clinical presentation.
Topics: Brain; Child; Diagnostic Imaging; Humans; Neuroimaging; Supratentorial Neoplasms
PubMed: 27889023
DOI: 10.1016/j.nic.2016.08.003 -
Proceedings of the National Academy of... Jan 2014Sex differences in human behavior show adaptive complementarity: Males have better motor and spatial abilities, whereas females have superior memory and social cognition... (Comparative Study)
Comparative Study
Sex differences in human behavior show adaptive complementarity: Males have better motor and spatial abilities, whereas females have superior memory and social cognition skills. Studies also show sex differences in human brains but do not explain this complementarity. In this work, we modeled the structural connectome using diffusion tensor imaging in a sample of 949 youths (aged 8-22 y, 428 males and 521 females) and discovered unique sex differences in brain connectivity during the course of development. Connection-wise statistical analysis, as well as analysis of regional and global network measures, presented a comprehensive description of network characteristics. In all supratentorial regions, males had greater within-hemispheric connectivity, as well as enhanced modularity and transitivity, whereas between-hemispheric connectivity and cross-module participation predominated in females. However, this effect was reversed in the cerebellar connections. Analysis of these changes developmentally demonstrated differences in trajectory between males and females mainly in adolescence and in adulthood. Overall, the results suggest that male brains are structured to facilitate connectivity between perception and coordinated action, whereas female brains are designed to facilitate communication between analytical and intuitive processing modes.
Topics: Adolescent; Brain; Child; Connectome; Diffusion Tensor Imaging; Female; Humans; Linear Models; Male; Sex Characteristics; Young Adult
PubMed: 24297904
DOI: 10.1073/pnas.1316909110 -
Acta Neurochirurgica Jun 2012
Topics: Brain; Brain Abscess; Female; Humans; Male; Postoperative Complications
PubMed: 22466154
DOI: 10.1007/s00701-012-1336-y -
Neonatology 2020Very preterm infants are at risk for adverse neurodevelopmental outcome. To better identify children without brain injury at risk for developmental sequelae, we assessed...
INTRODUCTION
Very preterm infants are at risk for adverse neurodevelopmental outcome. To better identify children without brain injury at risk for developmental sequelae, we assessed predictive values of supratentorial brain metrics in relation to outcome.
METHODS
Very preterm infants underwent magnetic resonance imaging (MRI) at term-equivalent age. Infants with any grade of supra- or infratentorial brain injury according to Kidokoro et al. [Pediatrics 2014;134:e444-53] were excluded. Supratentorial brain metrics (biparietal width, extracerebral space, interhemispheric distance) were measured and categorised using existing cut-off values. The Psychomotor Developmental Index (PDI) and Mental Developmental Index (MDI) were assessed using the Bayley Scales of Infant Development, second and third edition, at 2 years of age. Developmental delay was defined as a score <85. Positive and negative predictive values for developmental delay were calculated.
RESULTS
A total of 237 very preterm infants were enrolled. Of all infants, 59 (21.2%) showed developmental delay. Infants with z-scores less than -0.5 for biparietal width had significantly lower PDI (p = 0.039) and MDI (p = 0.042) than infants with normal z-scores. Enlargement of extracerebral spaces was also related to lower PDI (p = 0.047) and MDI (p = 0.036). Negative predictive value was highest when all brain metrics were within the normal range (PDI <85: 96.6%, MDI <85: 90.0%). Combining the biparietal width and the interhemispheric distance showed highest positive predictive values for developmental delay (MDI or PDI <85: 58.3%).
DISCUSSION
Supratentorial brain metrics are predictive for neurodevelopmental outcome in infants with ostensibly normal MRI. A combination of supratentorial brain metrics is most meaningful for identifying infants at risk for long-term sequelae.
Topics: Benchmarking; Brain; Brain Injuries; Child; Child Development; Child, Preschool; Developmental Disabilities; Humans; Infant; Infant, Newborn; Infant, Premature; Infant, Premature, Diseases
PubMed: 32396898
DOI: 10.1159/000506836 -
Neurology India 2022New controversies have raised on brain death (BD) diagnosis when lesions are localized in the posterior fossa. (Review)
Review
BACKGROUND
New controversies have raised on brain death (BD) diagnosis when lesions are localized in the posterior fossa.
OBJECTIVE
The aim of this study was to discuss the particularities of BD diagnosis in patients with posterior fossa lesions.
MATERIALS AND METHODS
The author made a systematic review of literature on this topic.
RESULTS AND CONCLUSIONS
A supratentorial brain lesion usually produces a rostrocaudal transtentorial brain herniation, resulting in forebrain and brainstem loss of function. In secondary brain lesions (i.e., cerebral hypoxia), the brainstem is also affected like the forebrain. Nevertheless, some cases complaining posterior fossa lesions (i.e., basilar artery thrombotic infarcts, or hemorrhages of the brainstem and/or cerebellum) may retain intracranial blood flow and EEG activity. In this article, I discuss that if a posterior fossa lesion does not produce an enormous increment of intracranial pressure, a complete intracranial circulatory arrest does not occur, explaining the preservation of EEG activity, evoked potentials, and autonomic function. I also addressed Jahi McMath, who was declared braindead, but ancillary tests, performed 9 months after initial brain insult, showed conservation of intracranial structures, EEG activity, and autonomic reactivity to "Mother Talks" stimulus, rejecting the diagnosis of BD. Jahi McMath's MRI study demonstrated a huge lesion in the pons. Some authors have argued that in patients with primary brainstem lesions it might be possible to find in some cases partial recovery of consciousness, even fulfilling clinical BD criteria. This was the case in Jahi McMath.
Topics: Brain; Brain Death; Brain Diseases; Brain Stem; Humans; Intracranial Pressure
PubMed: 35532637
DOI: 10.4103/0028-3886.344634 -
Handbook of Clinical Neurology 2017Supratentorial cavernous malformations are uncommon cerebral vascular lesions that may present many unique challenges for treating physicians. The vast majority will be... (Review)
Review
Supratentorial cavernous malformations are uncommon cerebral vascular lesions that may present many unique challenges for treating physicians. The vast majority will be discovered during workup for seizures or after symptomatic intracerebral hemorrhage. Supratentorial cavernous malformations are increasingly being discovered incidentally in patients who obtain brain imaging for unrelated reasons. Management strategies including watchful waiting, antiepileptic drug therapy, microsurgery, or an expanding array of "minimally invasive" therapies. Thus, clinical decision making is not always straightforward and a nuanced approach tempered by experience and good judgment is critical to achieving excellent clinical results.
Topics: Brain; Central Nervous System Vascular Malformations; Cerebral Hemorrhage; Humans; Magnetic Resonance Imaging; Seizures
PubMed: 28552151
DOI: 10.1016/B978-0-444-63640-9.00027-8 -
Journal of the National Medical... Aug 1989The common supratentorial congenital malformations of the brain were analyzed with magnetic resonance (MR) at the Children's Memorial Hospital in Chicago over a two-year... (Review)
Review
The common supratentorial congenital malformations of the brain were analyzed with magnetic resonance (MR) at the Children's Memorial Hospital in Chicago over a two-year period. Three hundred children with one or more of the following congenital malformations were imaged with MR: (1) dysgenesis of the corpus callosum; (2) holoprosencephaly; (3) migrational disorders; (4) cephaloceles; and (5) septo-optic dysplasia. The characteristic findings in each of these disorders are described based on the MR scans as well as the clinical spectrum.
Topics: Abnormalities, Multiple; Brain; Child, Preschool; Humans; Infant; Magnetic Resonance Imaging; Prognosis
PubMed: 2671396
DOI: No ID Found