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AI and Autoimmunity
Published in Louis J. Catania, AI for Immunology, 2021
Multiple sclerosis (MS): An algorithm was created that combines multiple machine-learning techniques to predict the expanded disability status scale (EDSS) score of patients with multiple sclerosis at two years solely based on age, sex, and fluid attenuated inversion recovery (FLAIR) MRI data. The algorithm combined several complementary predictors: a pure deep learning predictor based on a convolutional neural network (CNN) that learns from the images, as well as classical machine-learning predictors. The method predicted two-year clinical disability in patients with multiple sclerosis with a mean EDSS score error of 1.7. This supports the use of this model to predict EDSS score progression.27
Stroke and Transient Ischemic Attacks of the Brain and Eye
Published in Philip B. Gorelick, Fernando D. Testai, Graeme J. Hankey, Joanna M. Wardlaw, Hankey's Clinical Neurology, 2020
A TIA has been redefined as symptoms of focal neurologic dysfunction of less than 24-hour duration and with no CT or MRI diffusion-weighted imaging (DWI) or MRI fluid-attenuated inversion recovery (FLAIR) brain imaging evidence of infarction (Figures 12.10 and 12.11).1
Central Nervous System
Published in Pat Price, Karol Sikora, Treatment of Cancer, 2020
Standard imaging sequences include T1 pre and post contrast, T2, and fluid-attenuated inversion recovery (FLAIR) imaging. These define active tumor volume reflected in blood–brain barrier breakdown, increased water content, and increased cellularity, respectively. The utility of additional sequences is under active investigation. These include the use of methods that highlight normal and abnormal white matter tract structure (diffusion tensor imaging [DTI]), which may be used to delineate the extent of tumor infiltration and to aid the planning of radiotherapy. Advanced imaging also has an increased role in neuro-surgical planning, particularly the use of functional imaging to map areas of specific activity prior to planned resection.
Genetic diseases mimicking multiple sclerosis
Published in Postgraduate Medicine, 2021
Chueh Lin Hsu, Piotr Iwanowski, Chueh Hsuan Hsu, Wojciech Kozubski
MRI techniques such as 3D fluid attenuated inversion recovery (FLAIR) and double inversion recovery (DIR) are widely used in the diagnostics of demyelination diseases including MS and its genetic mimics. Better resolution due to the smaller slice thickness, multiplanar reconstructions and higher contrast-to-noise ratio are advantages of 3D FLAIR over its 2D counterpart. Several studies have shown the enhanced sensitivities of 3D FLAIR to juxta-cortical and infratentorial lesions, which are characteristics for MS and listed as 2 of the 4 CNS areas that must be investigated according to McDonald criteria for a MS diagnosis [27-29]. The degree of gray matter (GM) damage, especially cortical lesions, are suggested to be directly linked to the mobility and the levels of cognitive impairments in MS patients [30-32]. DIR, in contrast to the conventional MRI, is helpful in improving the visibility of GM cortical lesions; yet the differences in lesions volumes, subtypes, and their distinct anatomical locations can alter the reliability of DIR in GM cortical lesions identifications [33–35].
PRES secondary to autonomic dysreflexia: A case series and review of the literature
Published in The Journal of Spinal Cord Medicine, 2021
Molly E. Hubbard, Aaron A. Phillips, Rebecca Charbonneau, Jordan W. Squair, Ann M. Parr, Andrei Krassioukov
Upon arrival, he was at his neurologic baseline, with mean arterial pressure ranging from 80 to 90 mmHg; complaining only of headaches. Additional angiography of intracranial vessels did not demonstrate the previously seen pericallosal aneurysm seen on the CTA. He was diagnosed with AD based on BP parameters and symptoms and was found to have a urinary tract infection (UTI) to which his AD was attributed. Five days after his admission, he presented with headache, diaphoresis, bradycardia of 53 beats-per-minute and BP of 170/90 mmHg. He was treated with IV hydralazine, and his headache resolved with reduction of his BP to 91/47 mmHg, and HR of 85. CT of the brain did not demonstrate additional findings. Brain MRI obtained to evaluate for other causes of his headaches and seizures revealed symmetric subcortical foci of Fluid-Attenuated Inversion Recovery (FLAIR) signal centered around the left and right high central sulci, consistent with PRES (Fig. 3). He was monitored in the hospital for two additional days where his BP was seen to be stable, with no new neurologic deficits. He had no follow up at our institution.
Opsoclonus-myoclonus syndrome associated with herpes simplex virus infection: a case report
Published in International Journal of Neuroscience, 2021
Ya Chen, Doujia Chen, Xuejiao Zhou, Haiqing Zhang, Shusheng Liao, Zucai Xu, Ping Xu
A 54-year-old woman with no pre-existing disease was admitted to the local hospital because of an upper respiratory infection accompanied by dizziness, vomiting and fever. A brain magnetic resonance imaging (MRI) scan showed a high T2-fluid-attenuated inversion recovery (FLAIR) signal in the pons (Figure 1(a)). At that time, she was treated with intravenous acyclovir for 10 days by her attending physician for suspected viral encephalitis, and her symptoms improved. After 2 months and 15 days, the patient was transferred to our department due to a recurrence of dizziness and opsoclonus, truncal titubation, multifocal myoclonus, and generalized tremor. At the time of admission to our department, the patient’s vital signs were stable, and the neurological examination revealed opsoclonus, bilateral and multifocal myoclonus that was aggravated during movement, and postural and intention tremors. She could not maintain a standing position due to severe myoclonus and truncal titubation. The other signs were normal.