OBJECTIVES: This study was carried out to evaluate manganese exposure marker and the clinical significance of high signal intensity observed on brain magnetic resonance imaging(MRI) in mild steel/arc welders. METHODS: Brain MRI, blood and urinary manganese concentration measurements, physical and neurologic examinations, questionnaire and biochemistry were performed on 53 mild steel/arc welders(exposed group) and 112 non-manganese handling productive workers(control group). We calculated the pallidal index, the ratio of signal intensity of globus pallidus to subcortical frontal white-matter on sagittal 71-weighted MRI. And we studied the relationships between the pallidal index and other measurements. RESULTS: In 35(66.3%) exposed workers, high signal intensity were observed on the globus pallidus. Blood and urinary manganese levels were higher in exported group than control group. Pallidal index were significantly correlated with working duration, blood manganese level, urinary manganese level and positive rates of clinical symptoms and signs. CONCLUSIONS: The results of this study suggests that high signal intensity finding on brain MRI may be considered as useful tool for the evaluation of workers who have manganese exposure.
Biochemistry ; Brain* ; Globus Pallidus ; Magnetic Resonance Imaging* ; Manganese ; Neurologic Examination ; Questionnaires

Few studies have investigated cognitive impairment associated with globus pallidal lesion after acute mountain sickness (AMS). A 54-year-old mountaineer presented with a slowed response, social withdrawal, and apathy after exposure to high altitude. Neuropsychological evaluation revealed impairment in memory and frontal function. MRI revealed bilateral globus pallidal lesions and SPECT revealed decreased blood flow in the left temporal cortex. Symptoms and imaging findings were still impaired after 3 years. We speculate that globus pallidal lesions can cause cognitive dysfunction in AMS.
Altitude ; Altitude Sickness ; Apathy ; Globus Pallidus ; Humans ; Memory ; Middle Aged ; Tomography, Emission-Computed, Single-Photon

Hallervorden-Spatz disease is a rare, autosomal recessive disorder of mainly early childhood which is characterized by pigmentary degeneration of the globus pallidus, substantia nigra, and red nucleus. Clinically it manifests various symptoms and signs of extrapyramidal and pyramidal involvement. Authors report a 28-year-old female patient with suspected Hallervorden-Spatz disease in the aspects of clinical and MRI findings suggesting metal deposition in the globus pallidus, substantia nigra, and red nucleus on both side.
Adult ; Female ; Globus Pallidus ; Humans ; Magnetic Resonance Imaging ; Pantothenate Kinase-Associated Neurodegeneration* ; Red Nucleus ; Substantia Nigra

The experience of pediatric deep brain stimulation (DBS) of the globus pallidus internus (GPi) in the treatment of early-onset DYT1 generalized dystonia is still limited. Here, we report the surgical experience of bilateral GPi-DBS under general anesthesia by using microelectrode recording in a 7-year-old girl with early-onset DYT1 generalized dystonia. Excellent improvement of her dystonia without neurological complications was achieved. This case report demonstrates that GPi-DBS is an effective and safe method for the treatment of medically refractory early-onset DYT1 generalized dystonia in children.
Anesthesia, General ; Child ; Deep Brain Stimulation ; Dystonia ; Globus Pallidus ; Humans ; Microelectrodes

OBJECTIVEThe involvement of globus pallidus has been found in neonates with acute bilirubin encephalopathy (ABE), but so far the relationship between the severity of hyperbilirubinemia and changes of globus pallidus has not been studied further. The present study was conducted to understand possible relationship between the MRI signal changes of globus pallidus and severe hyperbilirubinemia in the neonates to provide evidences for diagnosis of bilirubin encephalopathy and prediction of outcome.

METHODSThirty-six neonates with severe hyperbilirubinemia (total serum bilirubin, i.e., TSB > 342 micromol/L) received MRI examination in a magnetic field with the strength of 1.5 - 3.0 Tesla at ages of 10 +/- 6 (2 - 34) days of life, of whom 15 were assessed as acute bilirubin encephalopathy (ABE). Routine T1WI with three kinds of sequences (SE, IR and FFE), T2WI and DWI with two kinds of sequences (EPI-SE and DW SSh SENSE) were applied. Two neuroradiologists who knew nothing about the clinical history analyzed MRI findings. TSB, unconjugated bilirubin (UCB), conjugated bilirubin (CB) and albumin (ALB) in all these neonates were measured with the same methods and analyzer.

RESULTSSymmetric hyperintense globus pallidus was shown on T1WI in 20 neonates, of whom three had symmetric hyperintense globus pallidus on T2WI (TSB = 745.3 micromol/L, 735.7 micromol/L, 707.6 micromol/L, respectively) at the same time. Remarkably higher TSB, molar ratio of TSB and ALB (B/A) and UCB were found in 20 neonates with hyperintense globus pallidus as compared to 16 cases without changes of globus pallidus (P = 0.000). No abnormal signal changes were found on DWI for all neonates; 9 neonates with TSB ranged from 342.0 micromol/L to 427.5 micromol/L did not show any abnormalities of globus pallidus, 3 of 7 neonates with TSB ranged from 427.5 micromol/L to 513.0 micromol/L, but 17 of 20 neonates with TSB more than 513.0 micromol/L showed distinct hyperintense globus pallidus. Hyperintense globus pallidus on T1WI was related to the severity of hyperbilirubinemia (Fisher's Exact Test, P = 0.000). Hyperintense globus pallidus on T1WI was found in all the 15 neonates with ABE (Fisher's Exact Test, P = 0.000), at the same time, hyperintense globus pallidus on T2WI was found in 3 cases with severe ABE. Six infants received the second MRI at ages from 2 months to 12 months, two of three infants with ABE in neonatal period showed the signal changes of globes pallidus from T1WI hyperintensity to T2WI hyperintensity and they developed cerebral palsy. The other one with normal signal showed hearing dysfunction. Another three infants without history of ABE did not show abnormal signals of globus pallidus and developed normally.

CONCLUSIONSThe symmetric involvement of globus pallidus with hyperintense signals on MRI T1WI indicates the severity of hyperbilirubinemia, which relates to time of exposure to hyperbilirubinemia and is a characteristic finding of ABE. The signal switch of hyperintense globus pallidus from T1WI to T2WI predicts poor outcome.

Bilirubin ; blood ; Globus Pallidus ; pathology ; Humans ; Hyperbilirubinemia, Neonatal ; diagnosis ; pathology ; Infant, Newborn ; Magnetic Resonance Imaging

A few neurosurgical alleviate to alleviate some dyskinesias of cerebral palsy(CP) have been tried. For the spastic and tremor type, the selective posterior rhizotomy and thalamotomy are regarded as treatments of choice but other dyskinesias remains a tough challenge. The authors have performed 48 cases of MRI-guided stereotactic thalamotomy(MGST) in 37 CP patients with mixed dyskinesias from Jun. '92 to Jan. '95 using CRW stereotactic frame and MRI, without any ventriculogram. Depending upon the types of main dyskinesias, the target including ventrolateral nucleus of thalamus or medial nucleus of globus pallidus was(were) selected. Clinical results were verified in terms of preoperative symptoms improvement and patient's satisfaction. In athetoid(42 MGSTs in 32CPs) : excellent 6, good 26, fair 10, and in dystonia(30 MGSTs in 23 CPs): excellent 2, good 18, fair 10, and in spasticity(20 in 17 CPs): excellent 3, good 12, fair 5, and in choreoor choreoathetoid(7 in 6 CPs) : good 5, fair 2. Recurrence of symptoms after operation was noted in 6 cases(12.5%). Postoperative morbidity including motor weakness, speech disturbance, swallowing difficulty, and sensory abnormality were transiently noted in 9 cases(18.8%). It is the authors observation that MGST seems to be one of the beneficial procedures for relieving symptoms of CP with mixed dyskinesias.
Cerebral Palsy* ; Deglutition ; Dyskinesias* ; Globus Pallidus ; Humans ; Magnetic Resonance Imaging ; Muscle Spasticity ; Recurrence ; Rhizotomy ; Thalamus ; Tremor

OBJECTIVE: The purpose of this study is to investigate the effect of ipsilateral subthalamic nucleus(STN) lesioning on the spontaneous behavioral changes and the alteration of neuronal activities of deep cerebral nuclei in the rat parkinsonian model with 6-hydroxydopamine(6-OHDA). METHODS: To identify the spontaneous behavioral changes, apomorphine-induced rotational test and forepaw adjusting step were performed. We subsequently investigated the alteration of neuronal activities in the substantia nigra pars reticulata(SNpr) and globus pallidus(GP), in order to compare them with the behavioral changes in rat parkinsonian models. RESULTS: The STN lesioning in the rat parkinsonian model clearly improved behavioral changes. Compared to the normal control rats, rat PD models exhibited a significant increase in mean firing rates and the percentage of bursting neurons in the STN and SNpr. In the STN-lesioned rat PD models, mean firing rates and the percentage of bursting neurons in the SNpr were reduced and those in the GP increased. CONCLUSION: STN lesioning induced behavior improvement in rat parkinsonian models seems to be consistent with the surgical outcomes of the STN stimulation therapy in advanced Parkinsonn's disease(PD). The alteration of the neuronal activities in the SNpr and GP suggests that these sites are responsible for the improvement of parkinsonian motor symptoms observed following STN lesioning in rat parkinsonian models. The significance of bursting activity in the SNpr and GP remains obscure. Further study is necessary to elucidate the pathophysiological mechanism of PD.
Animals ; Fires ; Globus Pallidus ; Kainic Acid* ; Neurons* ; Oxidopamine* ; Parkinson Disease ; Rats* ; Substantia Nigra ; Subthalamic Nucleus

OBJECTIVES: The objectives of this study were to clarify which biological manganese exposure indices reflect the pallidal signal intensities in magnetic resonance imaging (MRI) in liver cirrhotics. METHODS: We examined whole blood, plasma, RBC and urinary manganese concentrations, as well as, brain MRI in 22 cirrhotic patients and 10 healthy controls. From MRI scans we calculated the signal intensity of the globus pallidus using the pallidal index (PI), the ratio of the globus pallidus to subcortical frontal white-matter signal intensity in axial T1-weighted MRI planes multiplied by 100. In addition, we studied the relationships between PI and other measurements. RESULTS: The high signal intensity in the globus pallidus on T1-weighted MRI was observed in 18 (81.8%) patients. There was a significant correlation between whole blood and RBC manganese concentration, and PI on MRI. According to multiple linear regression, whole blood and RBC manganese concentration reflected PI on MRI better the other indices did. CONCLUSIONS: Whole blood and RBC manganese concentrations could be useful as biological manganese exposure indices that reflect PI on MRI.
Brain ; Globus Pallidus ; Humans ; Linear Models ; Liver* ; Magnetic Resonance Imaging* ; Manganese* ; Plasma

The author analysed CT findings and long-term outcomes of 67 patients with acute carbon monoxide poisoning. Low density lesions were demonstrated in 44 patients (65.7%). Hemorrhage and calcification also showed with low density lesions in 3 and 2 patients, respectively. The most common findings, seen in 22 patients, was bilaterally symmetrical round low density lesion in the globus pallidus and adjacent area of internal capsule with variable sizes. In 18 patients there were diffuse symmetrical low density lesion in the cerebral white matter, especially around the centrum semiovale, with slight or marked extension. Of 44 patients with CT abnormalities seven patients recovered without disability, fifteen recovered with some disability, eighteen remained in the vegetative state, and four died. The outcome of acute carbon monoxide poisoning depended on the severity of the cerebral white matter change in CT of brain. The size of the bilateral globus pallidus lesion was not heopful to determine the longterm outcome of acute carbon monoxide poisoning.
Brain* ; Carbon Monoxide Poisoning* ; Carbon Monoxide* ; Carbon* ; Globus Pallidus ; Hemorrhage ; Humans ; Internal Capsule ; Persistent Vegetative State

Chorea-acanthocytosis (ChAc) is a rare hereditary disorder characterized by involuntary choreiform movements and erythrocytic acanthocytosis. Pharmacotherapy for control of involuntary movements has generally been of limited benefit. Deep brain stimulation (DBS) has recently been used for treatment of some refractory cases of ChAc. We report here on the effect of bilateral high-frequency DBS of globus pallidus interna in a patient with ChAc.
Abetalipoproteinemia ; Chorea ; Deep Brain Stimulation* ; Drug Therapy ; Dyskinesias ; Globus Pallidus* ; Humans ; Neuroacanthocytosis*