It has been known that the vestibular system is concerned with feelings of dizziness or vertigo. The vestibulo-thalamic pathway has also been described previously. However, there has been no confirmative report so far regarding the pathway through the internal capsule to the cortex. We have experienced 13 patients with symptoms of dizziness and/or vertigo whose lesions are located only around the internal capsule, mainly at the posterior limb and/or the genu. It is suggestive that fibers with dizziness may pass through a part of the internal capsule, probably through some part of the posterior limb and/or the genu.
Adult ; Aged ; Basal Ganglia/*physiopathology ; Dizziness/*physiopathology ; Female ; Humans ; Male ; Middle Aged ; Neural Pathways/physiopathology

BACKGROUNDWriter's cramp is a type of task specific idiopathic focal dystonia and has an incompletely understood pathophysiology. The present study utilized functional magnetic resonance imaging (fMRI) to investigate what type of brain activity correlates with writer's cramp and its physiological mechanism.

METHODSTen patients with writer's cramp were age and gender matched with ten healthy control subjects in a block design. Subjects were scanned by fMRI while performing three consecutive, visually instructive, tasks with MR Vision 2000: (1) suppositional writing, (2) writing with finger and (3) writing with a pencil. Data was analysed using AFNI software for groups of patients and controls.

RESULTSThe patients with writer's cramp showed significant activations of contralateral basal ganglion (especially the putamen), motor cortex (primary sensorimotor cortex, supplementary motor cortex, premotor cortex) and ipsilateral cerebellar hemisphere in writing with a pencil compared with controls; whereas there was no obvious difference between patients and controls during writing with finger. Furthermore, these differences exist in the subtractive activated maps for "writing with a pencil" minus "writing with finger" of patients, when the activation of subcortical area and insula in controls disappeared.

CONCLUSIONSAbnormal activations of contralateral basal ganglion, motor cortex and ipsilateral cerebellar hemisphere of the patients with writer's cramp suggest dysfunction of basal ganglion and subcortical-cortical loop might play a pathophysiological role in writer's cramp.

Adult ; Aged ; Basal Ganglia ; physiopathology ; Brain ; physiopathology ; Cerebral Cortex ; physiopathology ; Dystonic Disorders ; physiopathology ; Female ; Humans ; Magnetic Resonance Imaging ; methods ; Male ; Middle Aged ; Positron-Emission Tomography

INTRODUCTIONRadiologists may encounter bilaterally symmetrical abnormalities of the basal ganglia on magnetic resonance imaging (MRI), typically in the context of diffuse systemic, toxic or metabolic diseases. A systematic approach and broad knowledge of pathology causing this uncommon group of conditions would be useful.

MATERIALS AND METHODSThis review uses illustrative images to highlight metabolic conditions, such as Leigh's syndrome, citrullinaemia, hypoglycaemia or carbon monoxide poisoning, as well as other causes of bilateral basal ganglia lesions such as osmotic myelinolysis, deep cerebral venous thrombosis and Creutzfeldt-Jakob disease.

RESULTSCareful assessment of radiological findings outside the basal ganglia, such as involvement of the cortex, white matter, thalamus and pons, together with clinical correlation, may be helpful in narrowing the differential diagnosis, and directing further radiological, biochemical or genetic investigations. Recent advances in MR technology have resulted in newer techniques including diffusion-weighted (DW) MR imaging and MR spectroscopy (MRS); these may be helpful if appropriately used.

CONCLUSIONSAbnormal MRI findings in the basal ganglia should not be interpreted in isolation. A systematic approach including DW MR imaging, MRS, and a broad knowledge of diffuse systemic, toxic or metabolic diseases is helpful.

Basal Ganglia Diseases ; diagnosis ; diagnostic imaging ; physiopathology ; Brain Diseases, Metabolic ; diagnosis ; diagnostic imaging ; Diagnosis, Differential ; Humans ; Magnetic Resonance Imaging ; Radiography

Of 32 cases suffering from acute carbon monoxide (CO) poisoning brainstem auditory evoked potential (BAEP) abnormalities were exhibited in 8 cases. the abnormalities of BAEPs could be divided into two patterns: a peripheral pattern (6 cases) of prolongation of latency to wave 1 without prolongation of interpeak latency, and a central pattern (2 cases) of prolongation of latencies to all waves and interpeak latencies. The indicence of BAEP abnormality tended to increase in accordance with an unconscious duration of more than 24 hours; during acute CO poisoning. A BAEP abnormality exhibiting a peripheral pattern usually returned to normal within one month after anoxia, but cases showing central pattern of BAEP abnormality died during acute anoxic insult due to the possible involvement of the brainstem. Thus, BAEPs can be used for evaluating the functional intergrity of the auditory pathways and for providing prognostic values in acute CO poisoning.
Acute Disease ; Adolescent ; Adult ; Aged ; Basal Ganglia/radiography ; Brain Stem/physiopathology* ; Carbon Monoxide Poisoning/physiopathology* ; Evoked Potentials, Auditory* ; Female ; Human ; Male ; Middle Age ; Tomography, X-Ray Computed

OBJECTIVETo study the characteristics of spectra on proton magnetic resonance spectroscopy (1H-MRS) and its value in patients with mitochondrial encephalomyopathy with lactic acidosis and stroke-like episodes (MELAS).

METHODSSeven clinically diagnosed patients with MELAS underwent magnetic resonance imaging (MRI) and 1H-MRS examinations. The 1H-MRS techniques, characteristics of the spectra, and its correlation with the laboratory tests were analyzed.

RESULTSCerebral abnormalities were revealed in all 7 patients on conventional MR images, and most abnormal signals were observed in bilateral occipital, parietal, and temporal lobes. We found 4 cases with basal ganglia involvement, 2 cases with mild frontal lobe lesions, and 1 case with involvement of lateral cerebral peduncles and thalami. Additionally, 1 patient was involved with left insular lobe. Spectra from prominent lesions in brain parenchyma showed lactate doublet peak in 6 patients, 3 of whom were also noted lactate peak in ventricular cerebrospinal fluid (CSF).

CONCLUSION1H-MRS may provide more direct information about the metabolism changes, which aids to affirm the diagnosis, and may replace the conventional invasive method of quantifying lactate in CSF.

Adolescent ; Adult ; Basal Ganglia ; pathology ; physiopathology ; Cerebral Cortex ; pathology ; physiopathology ; Child ; Female ; Humans ; Lactic Acid ; metabolism ; MELAS Syndrome ; diagnosis ; physiopathology ; Magnetic Resonance Imaging ; Magnetic Resonance Spectroscopy ; Male ; Parietal Lobe ; pathology ; physiopathology

OBJECTIVETo determine the role of extracellular signal-regulated kinase (ERK)1/2 during focal cerebral ischemia.

METHODSLeft middle cerebral artery occlusion (MCAO) was undergone after the introduction of a nylon suture to the left internal carotid artery in 70 male adult CD-1 mice. ERK 1/2 phosphorylation was detected using Western blot analysis, and the morphological feature was determined by immunohistochemistry. An ERK pathway inhibitor, 1,4-diamino-2,3-dicyano-1,4-bis[2-amino-phenylthio] butadiene (U0126), was administered intravenously 20 minutes before MCAO, and the neurological deficit levels and the infarct volumes were measured 24 hours after MCAO.

RESULTSPhosphorylated ERK 1/2 (pERK 1/2) activity increased after 30 minutes of MCAO and peaked at 2 hours. The immunohistochemical study displayed a large number of pERK 1/2 positive cells in the ischemic basal ganglion and surrounding cortex. Double-labeled fluorescent staining identified the pERK1/2 positive cells as neurons or astrocytes. In U0126 treated mice which had undergone 24 hours of MCAO, the neurological deficit levels and the infarct volumes were 44.6% and 45.8% respectively, less than those of the control mice.

CONCLUSIONSERK plays an important role in focal cerebral ischemia and inhibition of the ERK pathway can help protect against ischemic brain injury, which may provide a therapeutic approach for cerebral ischemia.

Animals ; Basal Ganglia ; pathology ; Brain Ischemia ; metabolism ; pathology ; physiopathology ; Butadienes ; pharmacology ; Cerebral Cortex ; pathology ; Immunohistochemistry ; Male ; Mice ; Mitogen-Activated Protein Kinases ; antagonists & inhibitors ; physiology ; Nitriles ; pharmacology ; Phosphorylation

AIMTo learn the condition of the memory and the visual space of the patient who has suffered from the infarction in basal ganglia region, and to analyze its impact on and the characteristics of the patients' cognition.

METHODSBy testing respectively on 21 subjects who were initially infarcted in basal ganglia with single focus on one side, and 21 healthy volunteers with corresponding age, gender and educational background with Rey-Osterrieth Complex Figure Scale (Rey), Clinical Memory Scale (CMS), Hospital Anxiety-Depression Scale (HAD), National Institute of Health Stroke Scale (NIHSS), Oxford Handicap Scale (OHS), Barthel Index (BI), and Aural Event Related Evoked Potential (AERP) as well.

RESULTSCompared with the control group, the patient group got higher scores of anxiety and depression in HAD), which showed absolutely statistical significance; they demonstrated longer reaction time in AERP, which also showed statistical significance; and in CMS. they displayed inferior performance in the free picture recall and the memory quotient (MQ), which again had statistical significance. However, compared with the control group, the patient group got scores with no significance in copy, immediate recall and delayed recall in Rey.

CONCLUSIONThe infarction in basal ganglia region with single focus on one side may impact on the patient's executive function, memory function and emotion. But no impact is showed on patient's visual space function.

Adult ; Aged ; Basal Ganglia ; pathology ; Brain Infarction ; pathology ; physiopathology ; psychology ; Case-Control Studies ; Evoked Potentials, Auditory ; Female ; Humans ; Male ; Middle Aged ; Neuropsychological Tests

Recent studies have reported that cognitive inflexibility associated with impairments in a frontal-striatal circuit and parietal region is a core cognitive deficit of obsessive-compulsive disorder (OCD). However, few studies have examined progressive changes in these regions following clinical improvement in obsessive-compulsive symptoms. To determine if treatment changes the aberrant activation pattern associated with task switching in OCD, we examined the activation patterns in brain areas after treatment. The study was conducted on 10 unmedicated OCD patients and 20 matched controls using event-related functional magnetic resonance imaging. Treatment improved the clinical symptoms measured by the Yale-Brown Obsessive Compulsive Scale and behavioral flexibility indicated by the switching cost. At baseline, OCD showed significantly less activation in the dorsal and ventral frontal-striatal circuit and parietal regions under the task-switch minus task-repeat condition compared with controls. After treatment, the neural responses in the ventral frontal-striatal circuit in OCD were partially normalized, whereas the activation deficit in dorsal frontoparietal regions that mediate shifting attention or behavioral flexibility persisted. It is suggested that altered brain activation in ventral frontal-striatal regions in OCD patients is associated with their cognitive flexibility and changes in these regions may underlie the pathophysiology of OCD.
Adult ; Basal Ganglia/*metabolism ; Behavioral Symptoms/drug therapy ; Female ; Frontal Lobe/*drug effects/physiopathology ; Humans ; Magnetic Resonance Imaging ; Male ; Obsessive-Compulsive Disorder/*drug therapy/physiopathology ; Parietal Lobe/*drug effects/physiopathology

INTRODUCTIONPosterior segment involvement has been described to be associated with central nervous system involvement in sarcoidosis as a result of direct sarcoid tissue infiltration or mass effect of a cerebral lesion. However, isolated intermediate uveitis occurring concurrently with central nervous system involvement prior to extensive systemic disease is rare.

CLINICAL PICTUREWe describe a patient with neuro-ophthalmic manifestations of intermediate uveitis and an enhancing basal ganglia lesion at initial presentation, in the absence of extensive systemic disease.

TREATMENTHe was treated with high-dose systemic steroids which was progressively tailed down over 6 months.

OUTCOMEThere was prompt resolution of vitritis with good preservation of visual acuity.

CONCLUSIONThe difficulties of the initial diagnosis of sarcoidosis and the indications for initiation of steroid therapy are illustrated. We use this case to emphasise the need for a high clinical suspicion of sarcoidosis in the presence of similar unusual and seemingly unrelated combinations of neurological manifestations so as to facilitate the prompt institution of appropriate treatment when indicated.

Adult ; Angiography ; Basal Ganglia ; diagnostic imaging ; physiopathology ; Brain Ischemia ; complications ; diagnosis ; Comorbidity ; Diagnosis, Differential ; Humans ; Magnetic Resonance Imaging ; Male ; Sarcoidosis ; complications ; diagnosis ; Time Factors ; Tomography, X-Ray Computed ; Uveitis ; complications ; diagnosis