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Biomedical subjects

R Gasparotti

Publications and source records attributed to R Gasparotti.

At least 19 recordsLinked to original sources
PubMed2006

Posttraumatic cerebral infarction in patients with moderate or severe head trauma.

OBJECTIVE: To evaluate the frequency, types, and location of posttraumatic cerebral infarction, to assess if secondary cerebral insults were associated with cerebral infarction, and to determine if cerebral infarction affected patients' outcome. METHODS: We based diagnosis of cerebral infarction on review of brain CT scans. We assessed frequency of secondary cerebral insults, including intracranial hypertension, cerebral hypoperfusion, systolic hypo- and hypertension, arterial blood oxygen desaturation, hypocapnia, and hyperthermia, using clinical charts. We used the Glasgow Outcome Scale to evaluate outcome at 6 months after trauma. RESULTS: Of the 89 patients included, a total of 28 cerebral infarctions were found in 17 cases (19.1%). Infarctions were territorial in 23 (82.1%) and watershed in 5 (17.9%) cases. Territorial infarctions were localized to the middle cerebral artery (n = 9, 32.1%), lenticulostriate arteries (n = 6, 21.4%), posterior cerebral artery (n = 3, 10.7%), anterior cerebral artery (n = 3, 10.7%), thalamoperforating arteries (n = 1, 3.6%), and basilar artery (n = 1, 3.6%) territories. Watershed infarctions were in the boundary (n = 4, 14.3%) and terminal (n = 1, 3.6%) zones. Intracranial hypertension was the only independent variable predicting cerebral infarction (odds ratio [OR] 13.3; 95% CI 2.8 to 62.6). At 6 months after trauma, there was a lower proportion of patients with good outcome among patients with cerebral infarction vs patients without (23.5 and 61.1%; p = 0.005). Cerebral infarction was the only independent predictor of 6-month outcome (OR of good outcome 0.19, 95% CI 0.06 to 0.66). CONCLUSIONS: The risk of developing posttraumatic cerebral infarction may be higher in patients with intracranial hypertension than in those without. Patients with posttraumatic cerebral infarction may be at increased risk of residual disability.

Adult↗
PubMed2005

Diffusion tensor imaging and voxel based morphometry study in early progressive supranuclear palsy.

BACKGROUND: A comprehensive characterisation of grey and white matter changes in progressive supranuclear palsy (PSP), the second most common extrapyramidal syndrome after Parkinson disease, is still not available. OBJECTIVE: To evaluate grey and white matter changes in mild PSP patients by voxel based morphometry (VBM) and diffusion tensor imaging (DTI), respectively. METHODS: 14 mild PSP patients and 14 healthy controls entered the study and underwent a clinical and neuropsychological evaluation according with a standardised assessment. Each subject had a structural magnetic resonance imaging (MRI) study. Processing analysis of MRI data was carried out according to optimised VBM and fractional anisotropy was determined. RESULTS: Compared with the controls, in PSP patients VBM analysis showed a significant clusters of reduced grey matter in premotor cortex, frontal operculum, anterior insula, hippocampus, and parahippocampal gyrus, bilaterally. With regard to subcortical brain regions, the pulvinar, dorsomedial and anterior nuclei of the thalamus, and superior and inferior culliculum were affected bilaterally. A bilateral decrease in fractional anisotropy in superior longitudinal fasciculus, anterior part of corpus callosum, arcuate fascicolus, posterior thalamic radiations, and internal capsule, probably involving the cortico-bulbar tracts, was present in PSP patients. CONCLUSIONS: These data provide evidence for both grey and white matter degeneration in PSP from the early disease stage. These structural changes suggest that atrophy of cortical and subcortical structures and neurodegeneration of specific fibre tracts contribute to neurological deficits in PSP.

Aged↗
PubMed2000

Brain magnetic resonance imaging and manganese exposure.

Due to its paramagnetic properties, manganese (Mn) can be effectively visualized by MRI. Mn accumulates selectively in the globus pallidus of basal ganglia, where it can produce high signals at brain magnetic resonance. These hyperintensities are bilateral, symmetrical, and visible in T1-weighted magnetic resonance imaging of different manganese overload conditions. A review of the literature shows identical findings in manganese exposed workers, hepatopatic patients, and patients undergoing total parenteral nutrition with excessive amount of manganese. Two indicators of exposure and hyperintensity were considered, represented respectively by the concentration of Mn in total blood (MnB), and the pallidal index (PI). These two indicators show a positive association, which indicates a possible continuum from normality to clinical stages both in workers occupationally exposed to Mn and in patients suffering from chronic liver disease. Since both MnB and PI show a high degree of variability, further research should be focused on the identification of more accurate indicators.

Brain↗
PubMed1999

Central nervous system involvement in systemic lupus erythematosus patients without overt neuropsychiatric manifestations.

OBJECTIVE: To verify whether features of CNS involvement can be detected in SLE patients without overt neuropsychiatric manifestations. METHODS: 114 SLE patients who had never received a diagnosis of neuropsychiatric lupus (never-NPSLE) were studied and compared to 65 SLE patients with known neuropsychiatric involvement (NPSLE). The study relied on evaluation of neurocognitive functions by means of a battery of neuropsychological tests, on psychiatric and neuropsychological assessments and on neuroimaging studies (computed tomography, magnetic resonance, single photon emission computed tomography (SPECT)). RESULTS: Clinical features, including disease duration/activity and pharmacological therapy, of never-NPSLE and NPSLE patients were similar. Short-term and long-term memory, visuo-spatial and verbal information processing were similarly compromised in never-NPSLE and in NPSLE patients; only attention was significantly more compromised in NPSLE patients. Psychiatric morbidity was higher than expected in never-NPSLE patients, although less than in the control neuropsychiatric group. Ischemic lesions, multiple small high intensity lesions and cortical atrophy, detected by CT and MR scans, as well as abnormal SPECT were also frequently detected in never-NPSLE patients. Interestingly, left parietal and occipital area hypoperfusion by SPECT was significantly more frequent in the patients with impaired visuo-spatial intelligence and short-term memory. CONCLUSIONS: Most abnormalities detected by available diagnostic tools and characteristics of neuropsychiatric SLE are also present in non-symptomatic patients. They may derive from an unexpected widespread involvement of the CNS and are not per se sufficient, in the absence of clinical manifestations, for a diagnosis of neuropsychiatric SLE.

Adult↗
PubMed1997

Motor evoked potentials and disability in secondary progressive multiple sclerosis.

BACKGROUND: To investigate the mechanisms underlying disability in multiple sclerosis (MS), 40 patients with the relapsing-remitting form of the disease and 13 patients with secondary progressive MS underwent multimodal evoked potential (EP), motor evoked potential (MEP), and spinal motor conduction time evaluation. Clinical disability was evaluated by the expanded disability status scale (EDSS) and functional system scales. In secondary progressive MS patients, magnetic resonance imaging (MRI) was used to obtain a semiquantitATive estimate of the total lesion load of the brain. RESULTS: Spinal motor conduction time was significantly longer in secondary progressive MS patients than controls (p < 0.001) and relapsing-remitting MS patients (p < 0.05), but did not differ between relapsing-remitting patients and controls. Spinal motor conduction times also correlated directly with EDSS scores (p < 0.001) and pyramidal functional system scores (p < 0.001). Brain lesion load (4960.3 +/- 3719.0 mm2) and the total number of lesions (67.7 +/- 37.0) in secondary progressive MS did not correlate with disability scores. For the following EPs, the frequencies of abnormalities were significantly higher in secondary progressive MS patients than relapsing-remitting patients: visual evoked potentials (p < 0.05), somatosensory evoked potentials and upper limb motor evoked potentials (p < 0.01), and brainstem auditory evoked potentials, lower limb somatosensory evoked potentials and lower limb motor evoked potentials (p < 0.001). CONCLUSIONS: These findings suggest that disability in secondary progressive MS patients is mainly due to progressive involvement of corticospinal tract in the spinal cord.

Adult↗
PubMed1997

The effect of imprecise repositioning on lesion volume measurements in patients with multiple sclerosis.

In this study, we evaluated the effect of imprecision in patient repositioning encountered in real life on multiple sclerosis (MS) lesion volumes measured from MRIs. We also evaluated two putative methods for reducing the variability in these lesion volume measurements: first, a reduction of slice thickness (from the conventional 5 mm to 3 mm) and second, the application of a new repositioning technique based on the use of head immobilization shells. We evaluated the errors in lesion volume by scanning 10 patients a total of four times using the two slice thicknesses and two repositioning methods (conventional and using a head immobilization shell). The mean absolute percentage difference between two corresponding scans was 6.8% (range, 1.24 to 11%) using conventional slice thickness and repositioning, 4.1% (range, 0.7 to 5.56%) using conventional slice thickness and head immobilization shells, 2.6% (range, 0.8 to 6.66%) using the conventional repositioning technique and 3-mm slice thickness, and 1.4% (range, 0.2 to 6.14%) using slice thickness of 3 mm and head immobilization shells. These mean absolute differences were significantly different (p = 0.0008). Our results indicate that the effect of repositioning errors of the order of those that can be encountered in the daily life situation of clinical trials affects significantly lesion load measurements in MS and that the combined use of thinner slices and more accurate repositioning techniques can markedly improve the reproducibility of such measurements.

Adult↗
PubMed1997

Three-dimensional MR myelography of traumatic injuries of the brachial plexus.

PURPOSE: To determine the diagnostic accuracy of three-dimensional MR myelography in the evaluation of traumatic injuries of the brachial plexus. METHODS: Twenty patients with clinical and electromyographic evidence of traumatic brachial plexopathy were examined with three-dimensional MR myelography, conventional cervical myelography, and CT myelography 1 to 9 months after trauma. Three-dimensional MR myelography was performed on a 1.5-T MR unit with a constructive interference in steady state (CISS) technique. For each patient, maximum intensity myelographic projections and multiplanar reconstruction reformatted 1-mm axial sections were obtained from the same 3-D data set. Three-dimensional MR myelographic findings were compared with findings at cervical myelography and CT myelography. Surgical findings were available for comparison in 13 patients. RESULTS: Three-dimensional MR myelography enabled detection of meningoceles with avulsed or intact nerve roots, partial or complete radicular avulsions without disruption of the thecal sac, dural sleeve abnormalities, and dural scars. Assuming cervical myelography and CT myelography as the standards of reference, 3-D MR myelography showed 89% sensitivity, 95% specificity, and 92% diagnostic accuracy in the evaluation of nerve root integrity. CONCLUSION: Three-dimensional MR myelography can show the majority of traumatic lesions that involve the proximal portion of the brachial plexus in a single rapid examination. On the basis of our findings, we propose this technique as a screening examination for patients with traumatic brachial plexus palsy.

Adolescent↗
PubMed1996

Triple dose of gadolinium-DTPA and delayed MRI in patients with benign multiple sclerosis.

OBJECTIVES: To evaluate whether a triple dose of gadolinium-DTPA (Gd-DTPA) or delayed MRI increase the number, size, and conspicuousness of enhancing lesions in patients with benign multiple sclerosis. METHODS: T1 weighted brain MRI was carried out on 20 patients with benign multiple sclerosis (expanded disability status scale < 3 with a disease duration > 10 years) in two sessions. In the first session, one scan was obtained before and two scans five to seven minutes and 20-30 minutes after the injection of 0.1 mmol/kg Gd-DTPA (standard dose). In the second session, six to 24 hours later, the same procedure was repeated with 0.3 mmol/kg Gd-DTPA (triple dose). RESULTS: Nine enhancing lesions were found in seven patients (35%) using the standard dose of Gd-DTPA. The numbers of enhancing lesions increased to 13 (P = 0.03) and the number of patients with such lesions to eight (40%) on the delayed standard dose scans. On the early triple dose scans, we found 19 enhancing lesions in 10 patients (50%). The number of enhancing lesions was significantly higher (P = 0.01) than that obtained with the early standard dose. The number of enhancing lesions was 18 and the number of "active" patients 11 (55%) on the delayed triple dose scans. The enhancing areas increased progressively from the early standard dose scans to the delayed triple dose scans. The contrast ratios of the lesions detected in early standard dose scans was lower than those of lesions present in the early (P = 0.01) and delayed (P = 0.04) triple dose scans. CONCLUSIONS: More enhancing lesions were detected in patients with benign multiple sclerosis with both delay of MRI and the use of triple dose of Gd-DTPA suggesting that the amount of inflammation in the lesions of such patients is mild and heterogeneous.

Gadolinium DTPA↗
PubMed1995

Transcranial Doppler sonography and magnetic resonance angiography in the assessment of collateral hemispheric flow in patients with carotid artery disease.

BACKGROUND AND PURPOSE: The aim of this investigation was to compare the respective efficacy of transcranial Doppler sonography (TCD) and magnetic resonance angiography (MRA) for the assessment of intracranial hemodynamics in patients with extracranial occlusion or severe stenosis of the internal carotid artery (ICA). METHODS: Twenty-five patients with unilateral ICA occlusion (n = 20) or tight stenosis (n = 5) demonstrated by duplex scanning or angiography were studied with both TCD and MRA. Three-dimensional time-of-flight MRA was used for the evaluation of extracranial-intracranial ICAs. Collateralization through the circle of Willis was investigated by means of selective two-dimensional MRA with presaturation of the carotid siphon, ophthalmic artery, or basilar artery. TCD was performed according to published standards: Anterior, middle, and posterior cerebral arteries were insonated through the temporal window, and carotid siphon and ophthalmic artery were assessed through a transorbital approach. Collateralization through the anterior circle of Willis was assumed if anterior cerebral artery flow was reversed, through the external carotid artery if ophthalmic artery flow was reversed, and through the basilar artery if the ratio of ipsilateral to contralateral posterior cerebral artery velocity was greater than 50%. TCD and MRA were performed by different investigators unaware of the results obtained with the other technique. RESULTS: In every case time-of-flight MRA demonstrated the ICA occlusion or stenosis. There was an excellent correlation (kappa = 0.64) between TCD and MRA in assessing the hemodynamic contribution of the anterior part of the circle of Willis, whereas MRA was unable to detect the anastomotic pathway of the ophthalmic artery (kappa = 0.32). The contribution of the posterior communicating artery was difficult to assess with both techniques, but in three cases only MRA showed unequivocal evidence of collateralization. In three cases of middle cerebral artery stenosis TCD was superior to MRA in demonstrating the patency of the vessel. CONCLUSIONS: TCD and MRA should be considered complementary techniques. Combining the findings of both examinations may help to better understand the changes in intracranial hemodynamics produced by extracranial carotid occlusion. The contribution of the ophthalmic pathway, although important for the intraorbital structures, is probably of limited functional significance to the hemispheric blood supply.

Adult↗
PubMed1995

Ruptured cerebral aneurysms operated on with only MRA. Reports of two cases.

Two cases of ruptured aneurysms of anterior communicating artery were reported. The aneuryms were showed only by means of MR angiography and operated on without conventional angiography, since patients' allergy to drugs and medium contrast. The MRA showed precisely the sites of the aneurysm and the directions of the sac, but underestimated the size of the sac. In spite of the lack of angiograms induced a great caution during the dissection of the aneurysm and made necessary a larger operative field, anyway clipping of the aneurysm's neck was performed without great difficulties.

Adult↗
PubMed1994

[Subarachnoid hemorrhage: assessment in the acute phase with angiography, with high-resolution magnetic resonance (angio-MR)].

Previous reports demonstrated that Magnetic Resonance Angiography (MRA) is a reliable means of diagnosing intracerebral aneurysms. However, in these early studies MRA was performed in patients with cerebral aneurysms already proved by intraarterial angiography. Our study was aimed at investigating the clinical feasibility and the diagnostic accuracy of high-resolution MRA in patients with acute subarachnoid hemorrhage. Twenty-five patients (15 women, 10 men) with CT diagnosis of subarachnoid hemorrhage were prospectively examined with high-resolution MRA within 24 hours of bleeding. All patients underwent intraarterial digital subtraction angiography (IA DSA) immediately after MRA examination. MRA studies were performed with a 1.5-T unit. MRA examinations of the cerebral vessels consisted of axial excitation of two 50-mm volume slabs, with 25% overlap, covering the cerebral circulation from the vertebro-basilar junction to the pericallosal artery. Pulse sequence variables were optimized to reduce voxel size (0.62 x 0.62 x 0.78) and to increase spatial resolution (160-mm FOV, 256 x 256 matrix, 0.78-mm slice thickness) while keeping S/N ratio high. The maximum intensity projection (MIP) reconstruction algorithm was used. The examination lasted nearly 20 minutes. Four MRA examinations (16%) were considered inadequate for diagnosis because of motion artifacts. High-resolution MRA detected 20 of 21 aneurysms in 17 patients, with 1 false positive and 1 false negative. Two patients had multiple aneurysms, 2 and 4 respectively, all of them detected by MRA. No cause of subarachnoid hemorrhage was found by IA DSA in 4 patients, while MRA studies were considered negative in 3 patients. Nineteen aneurysms were surgically clipped, while 2 basilar artery aneurysms were occluded by intravascular treatment. MRA and DSA findings were compared with surgical findings. Relative to IA DSA, MRA exhibited 95% sensitivity and 95% specificity. Aneurysm size ranged 2-10 mm: the smallest aneurysm detected by MRA was 2.5 mm. Anatomical and morphological agreement between MRA and IA DSA was excellent, with only slight MRA underestimation of the aneurysm size in 25% of cases and overestimation in 15% of cases. The aneurysm neck was shown by MRA in 60% and by IA DSA in 81% of cases. High-resolution MRA proved to be especially useful in complex anatomical sites where the direction of the aneurysm could be clearly demonstrated through the accurate selection of the appropriate projection angle and the careful examination of direct axial images.(ABSTRACT TRUNCATED AT 400 WORDS)

Acute Disease↗
PubMed1993

Ischaemic pontomedullary transection with incomplete locked-in syndrome. A case report with MRI.

We describe a case of incomplete locked-in syndrome (LIS) due to basilar artery thrombosis, in which MRI showed a complete, sharply demarcated infarct at the pontomedullary junction. This supports experimental data showing that the lower reticular formation is not critical for the maintenance of consciousness. To our knowledge, this is the first reported case of ischaemic pontomedullary transection with LIS.

Brain Ischemia↗
PubMed1993

Serial study of neuropsychological performance and gadolinium-enhanced MRI in MS.

Many multiple sclerosis patients show cognitive decline, although no definite correlation between brain demyelination at MRI and neuropsychological performance has been found so far. We submitted a group of nine relapsing-remitting, mildly disabled patients to both serial gadolinium-DTPA enhanced MRI and neuropsychological evaluation in a follow up period of three months. Despite the great variability in acute lesions' load, no overall decline in test, performance was found. Furthermore, in selected cases whose test scores declined at follow up, no concordance with the new lesion load was found.

Adult↗
PubMed1992

Gadolinium-pentetic acid magnetic resonance imaging in patients with relapsing remitting multiple sclerosis.

Ten patients with relapsing-remitting multiple sclerosis have been studied by serial gadolinium-pentetic acid magnetic resonance imaging (MRI) every 14 days for 3 months. At the end of the follow-up, seven relapses occurred in six patients; no therapy was administered during the study. Ninety-three enhancing lesions were collected in eight patients. With regard to the duration of the enhancement, 32 lesions were detected in only one MRI scan and 32 were found in more MRI scans (most of the lesions occurring in two serial examinations). Four old lesions increased their size with delayed enhancement. Correlation was found between the relapses and the gadolinium-pentetic acid-enhancing areas only for one brain-stem and two cervical spinal cord lesions. Gadolinium-pentetic acid MRI provides useful information about activity of the disease that cannot be obtained clinically even if the dynamic of the lesions may be undervalued in old plaques.

Adult↗
PubMed1992

Giant congenital nevus and chronic progressive ascending hemiparesis (Mills syndrome). Report of a case.

We describe the case of a 20 year old boy with a giant congenital nevus who developed a chronic progressive ascending hemiparesis. The association of the pigmented lesion with a focal neurological deficit is pathognomonic for neurocutaneous melanosis complicated by a leptomeningeal melanoma. MR imaging at 1.5 tesla ruled out such a possibility and showed a small aspecific pontine lesion along the route of the corticospinal tract. We discuss possible etiologies.

Adult↗