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Topakian R.,Wagner Jauregg Hospital | Pischinger B.,Wagner Jauregg Hospital | Stieglbauer K.,Government of Upper Austria | Pichler R.,Institute of Nuclear Medicine
Cephalalgia | Year: 2014

Background: Sporadic hemiplegic migraine (SHM) is defined as migraine attacks associated with some degree of motor weakness during the aura phase and where no first-degree relative has identical attacks. SHM has a wide inter- and intraindividual clinical spectrum and, in case of prolonged aura symptoms and disturbed consciousness, can mimic several other acute neurological diseases. Case: In 1996, during his wedding night, a 28-year-old man developed left face, arm and leg weakness, nausea and a throbbing headache. Neurological examination on presentation revealed stupor, fever, meningism and left hemiplegia. There were no abnormalities on emergency magnetic resonance. Lumbar puncture showed mild lymphocytic pleocytosis and slightly elevated protein. He received symptomatic treatment. Subsequent genetic analysis revealed the T666M mutation in the CACNA1A gene of chromosome 19. He was diagnosed with SHM. In 2005, at the end of another episode of hemiplegic migraine (HM), he for the first time developed an episode of paranoid psychosis with anxiety and visual hallucinations. The psychiatric symptoms resolved within a week. Discussion: All perfusion SPECTand transcranial Doppler studies performed in the first days of HM attacks were consistent with hyperemia of the hemisphere contralateral to the neurological signs. FDG-PET/CT in January 2013 revealed a diffusely reduced glucose metabolism of the supratentorial cortex and marked asymmetric hypometabolism of the left cerebellum. The finding of progressive cortical metabolic dysfunction over years appears as a new finding. Glucose hypometabolism may indicate primary neuronal dysfunction as the cause of the prolonged deficits. © 2013 International Headache Society.

Topakian R.,Klinikum Wels Grieskirchen | Wimmer S.,Institute of Radiology | Pischinger B.,Wagner Jauregg Hospital | Pichler R.,Institute of Nuclear Medicine
BMJ Case Reports | Year: 2014

Hereditary neuropathy with liability to pressure palsies (HNPP) is an autosomal-dominant disorder associated with recurrent mononeuropathies following compression or trivial trauma. Reports on sciatic neuropathy as the presenting manifestation of HNPP are very scarce. We report on a 21-year-old previously healthy man who was admitted with sensorimotor deficits in his left leg. He had no history of preceding transient episodes of weakness or sensory loss. Clinical and electrophysiological examinations were consistent with sciatic neuropathy. Cerebrospinal fluid investigation and MRI of the nerve roots, plexus, and sciatic nerve did not indicate the underlying aetiology. When extended electrophysiological tests revealed multiple subclinical compression neuropathies in the upper limbs, HNPP was contemplated and eventually confirmed by genetic testing.

Zamagni E.,University of Bologna | Patriarca F.,University of Udine | Nanni C.,University of Bologna | Zannetti B.,University of Bologna | And 13 more authors.
Blood | Year: 2011

We prospectively analyzed the prognostic relevance of positron emission tomography-computed tomography (PET/CT) at diagnosis, after thalidomide- dexamethasone (TD) induction therapy and double autotransplantation (ASCT) in 192 newly diagnosed multiple myeloma (MM) patients. Presence at baseline of at least 3 focal lesions (FLs; 44% of cases), a standardized uptake value (SUV) > 4.2 (46%), and extramedullary disease (EMD; 6%) adversely affected 4-year estimates of progression-free survival (PFS; ≥ 3 FLs: 50%; SUV > 4.2: 43%; presence of EMD: 28%). SUV > 4.2 and EMD were also correlated with shorter overall survival (OS; 4-year rates: 77% and 66%, respectively). Persistence of SUV > 4.2 after TD induction wasan early predictor for shorter PFS. Three months after ASCT, PET/CT was negative in 65% of patients whose 4-year rates of PFS and OS were superior to those of PETpositive patients (PFS:66%and OS: 89%). In a multivariate analysis, both EMD and SUV > 4.2 at baseline and persistence of fluorodeoxyglucose (FDG) uptake afterASCTwere independent variables adversely affecting PFS. PET/CT involvement at diagnosis, after novel agent-based induction and subsequentASCTis a reliable predictor of prognosis in MM patients. This study is registered at www.clinicaltrials.gov as NTC01341262. © 2011 by The American Society of Hematology.

Levy S.,The Academic College of Tel-Aviv-Yaffo | Segev M.,The Academic College of Tel-Aviv-Yaffo | Reicher-Atir R.,The Academic College of Tel-Aviv-Yaffo | Steinmetz A.,Institute of Nuclear Medicine | And 4 more authors.
European Journal of Gastroenterology and Hepatology | Year: 2014

Objective: To compare perceptions of patients and gastroenterologists regarding irritable bowel syndrome (IBS) and inflammatory bowel disease (IBD). Methods: The Illness Perception Questionnaire-Revised was sent to 150 randomly selected hospital-based and community-based gastroenterologists nationwide. Participants were instructed to refer their responses to either IBS or IBD. Patients were recruited during a regular visit to the Gastroenterology Department of a tertiary medical center and completed the same questionnaire. Findings were analyzed according to illness and group. Results: Questionnaires were returned by 55 physicians (29 referred to IBS, 26 to IBD) and 58 patients. Physicians and patients stated that IBD has more severe consequences and benefits more from medical treatment (P<0.05), and that patient coherence is higher for IBD than IBS (P<0.05). Physicians stated that psychological attributes and accidents/injuries play a greater causative role in IBS than in IBD (P<0.01 and P<0.05, respectively). Conversely, patients found no such difference. More patients than physicians attributed both illnesses to risk factors (P=0.07). Both groups believed that the immune system is a more important causative factor in IBD than IBS (P<0.01). Conclusion: The different views of gastroenterologists and patients in terms of the involvement of psychological attributes, risk factors, and accidents/injuries in IBD and IBS could affect the patient-health provider relationship and adversely impact treatment outcome. Copyright ©2013 Wolters Kluwer Health | Lippincott Williams & Wilkins.

Holman B.F.,Institute of Nuclear Medicine | Cuplov V.,Institute of Nuclear Medicine | Millner L.,Institute of Nuclear Medicine | Hutton B.F.,Institute of Nuclear Medicine | And 4 more authors.
Physics in Medicine and Biology | Year: 2015

Recently, there has been an increased interest in imaging different pulmonary disorders using PET techniques. Previous work has shown, for static PET/CT, that air content in the lung influences reconstructed image values and that it is vital to correct for this 'tissue fraction effect' (TFE). In this paper, we extend this work to include the blood component and also investigate the TFE in dynamic imaging. CT imaging and PET kinetic modelling are used to determine fractional air and blood voxel volumes in six patients with idiopathic pulmonary fibrosis. These values are used to illustrate best and worst case scenarios when interpreting images without correcting for the TFE. In addition, the fractional volumes were used to determine correction factors for the SUV and the kinetic parameters. These were then applied to the patient images. The kinetic parameters K1 and Ki along with the static parameter SUV were all found to be affected by the TFE with both air and blood providing a significant contribution to the errors. Without corrections, errors range from 34-80% in the best case and 29-96% in the worst case. In the patient data, without correcting for the TFE, regions of high density (fibrosis) appeared to have a higher uptake than lower density (normal appearing tissue), however this was reversed after air and blood correction. The proposed correction methods are vital for quantitative and relative accuracy. Without these corrections, images may be misinterpreted. © 2015 Institute of Physics and Engineering in Medicine.

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