• 생물정신의학
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• 제3권2호
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• pp.203-210
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• 1996

알쯔즈하이머형 치매 환자의 뇌자기공명영상(腦磁氣共鳴影像)에 나타난 뇌위축(腦萎縮) 및 백질병변(白質病變)과 치매 발병연령(發病年齡)과의 상관관계(相關關係)를 밝히기 위해, NINCDS-ADRDA 진단기준(診斷基準)에 의한 조발성(早發性)(n=9) 및 만발성(慢發性)(n=18) 알쯔하이머형 치매군과 각각의 정상대조군(n=10 : n=11)에서 뇌위축(腦萎縮)은 대뇌피질위축(大腦皮質萎縮)과 뇌실확장(腦室擴張)의 체적(體積)을 계측(計測)하고 백질병변(白質病變)은 뇌실주변, 심부백질, 기저핵 및 천막하영역의 백질(白質) 신호(信號) 고강도(高剛度)의 반정량적(半定量的) 평가척도(評價尺度)로 측정하였다. 조발성(早發性) 환자군의 뇌위축(腦萎縮)은 대조군보다 유의하게 컸고(p<0.05) 백질병변(白質病變)에서는 모든 영역에서 차이가 없었으며, 만발성(慢發性) 환자군은 뇌위축(腦萎縮) 정도에서는 대조군과 차이가 없었으나 백질병변(白質病變)은 심부백질 및 시상에서 유의한 차이(p<0.05)를 보였고 나머지 모든 영역에서도 대조군보다 심한 경향을 보였다. 알쯔하이머형 치매가 (1) 뇌위축(腦萎縮)을 주로 보이고 백질병변(白質病變)은 심하지 않은 조기발병군(早期發病郡)과, (2) 백질병변(白質病變)이 두드러지고 뇌위축(腦萎縮)은 심하지 않은 만기발병군(晩期發病郡)으로 나누어질 가능성과 양군의 병태생리(病態生理)가 상이(相異)할 가능성이 시사되었다.

• Investigative Magnetic Resonance Imaging
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• 제25권2호
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• pp.101-108
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• 2021

Purpose: To identify characteristic magnetic resonance imaging (MRI) features to differentiate between Krabbe disease and metachromatic leukodystrophy (MLD) in young children. Materials and Methods: We collected all confirmed cases of Krabbe disease and MLD between October 2004 and September 2020 at Seoul National University Children's Hospital. Patients with initial MRI available were included. Their initial MRIs were retrospectively reviewed for the following: 1) presence of white matter signal abnormality involving the periventricular and deep white matter, subcortical white matter, internal capsule, brainstem, and cerebellum; 2) presence of volume decrease and signal alteration in the corpus callosum and thalamus; 3) presence of the tigroid sign; 4) presence of optic nerve hypertrophy; and 5) presence of enhancement or diffusion restriction. Results: Eleven children with Krabbe disease and 12 children with MLD were included in this study. There was no significant difference in age or symptoms at onset. Periventricular and deep white matter signal alterations sparing the subcortical white matter were present in almost all patients of the two groups. More patients with Krabbe disease had T2 hyperintensities in the internal capsule and brainstem than patients with MLDs. In contrast, more patients with MLD had T2 hyperintensities in the splenium and genu of the corpus callosum. No patient with Krabbe disease showed T2 hyperintensity in the corpus callosal genu. A decrease in volume in the corpus callosum and thalamus was more frequently observed in patients with Krabbe disease than in those with MLD. Other MRI findings including the tigroid sign and optic nerve hypertrophy were not significantly different between the two groups. Conclusion: Signal abnormalities in the internal capsule and brainstem, decreased thalamic volume, decreased splenial volume accompanied by signal changes, and absence of signal changes in the callosal genu portion were MRI findings suggestive of Krabbe disease rather than MLD based on initial MRI. Other MRI findings such as the tigroid sign could not help differentiate between these two diseases.

• 생물정신의학
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• 제22권3호
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• pp.140-148
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• 2015

Objectives The aim of this study is to investigate the correlation between degenerative changes in brain [i.e., global cortical atrophy (GCA), medial temporal atrophy (MTA), white matter hyperintensities (WMH)] and neurocognitive dysfunction in Korean patients with Alzheimer's disease. Methods A total of 62 elderly subjects diagnosed with Alzheimer's disease were included in this study. The degenerative changes in brain MRI were rated with standardized visual rating scales (GCA or global cortical atrophy, MTA or medial temporal atrophy, and Fazekas scales) and the subjects were divided into two groups according to the degree of degeneration for each scale. Cognitive function was evaluated with Korean version of the Consortium to Establish a Registry for Alzheimer's Disease (CERAD-K) and several clinical features, including apolipoprotein E ${\varepsilon}4$ status, lipid profile and thyroid hormones, were also examined. Chi-square test and Fisher's exact test were performed to analyze the relationship between the degree of cerebral degeneration and neurocognitive functions. Results Demographic and clinical features, except for the age, did not show any significant difference between the two groups divided according to the degree of cerebral degenerative changes. However, higher degree of GCA was shown to be associated with poorer performance in verbal fluency test, word list recall test, and word list recognition test. Higher degree of MTA was shown to be associated with poorer performance in Mini-Mental State Examination in the Korean Version of CERAD Assessment Packet (MMSE-KC), word list recognition test and construction praxis recall test. Higher degree of white matter hyperintensities was shown to be associated with poorer performance in MMSE-KC. Conclusions Our results suggest that severe brain degeneration shown in MRI is associated with significantly poorer performance in neurocognitive tests in patients with Alzheimer's disease. Moreover, the degree of GCA, MTA and white matter hyperintensities, represented by scores from different visual rating scales, seems to affect certain neurocognitive domains each, which would provide useful information in clinical settings.

• Annals of Clinical Neurophysiology
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• 제20권2호
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• pp.79-84
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• 2018

Background: Pulsatility of cerebral arteries and aortic stiffness have been associated with white matter hyperintensities (WMH). We explored which is better correlated with the severity of WMH in a population with acute lacunar infarct. Methods: We included patients with acute small subcortical infarcts who underwent transcranial Doppler (TCD) and brachial ankle pulse wave velocity (baPWV). Exclusion criteria were any stenosis or occlusion on major cerebral arteries on magnetic resonance angiography; poor temporal insonation windows; ankle brachial index < 0.9; and atrial fibrillation. We assessed the performance of the pulsatility index of bilateral middle cerebral arteries (PI-MCA) and baPWV for predicting moderate-to-severe WMH, defined as an Age Related White Matter Changes score > 5, and then sought to find independent predictors using binary logistic regression analysis. Results: Eighty-three patients (56 males, mean age $61.5{\pm}11.4$) participated in the study. Uni-variate analysis showed old age and high PI-MCA were significantly correlated with moderate-to-severe WMH. However, baPWV was not associated with the severity of WMH. Multivariate analysis revealed old age (odds ratio per 1-year increase, 1.068; p = 0.044) and upper tertile of PI-MCA (odds ratio, 5.138; p = 0.049) were independently associated with moderate-to-severe WMH. Receiver-operating characteristics showed PI-MCA differentiated those with and without moderate-to-severe WMH with an area under the curve of 0.719. Conclusions: PI-MCA derived from TCD was better correlated with the severity of WMH than baPWV in a population with lacunar infarction. Pulsatility of cerebral arteries may better predict cerebral small vessel disease than the aortic stiffness index.

• Korean Journal of Radiology
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• 제23권10호
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• pp.986-997
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• 2022

Objective: Whether metabolic redistribution occurs in patients with white matter hyperintensities (WMHs) on magnetic resonance imaging (MRI) is unknown. This study aimed 1) to propose a measure of the brain metabolic network for an individual patient and preliminarily apply it to identify impaired metabolic networks in patients with WMHs, and 2) to explore the clinical and imaging features of metabolic redistribution in patients with WMHs. Materials and Methods: This study included 50 patients with WMHs and 70 healthy controls (HCs) who underwent ¹⁸F-fluorodeoxyglucose-positron emission tomography/MRI. Various global property parameters according to graph theory and an individual parameter of brain metabolic network called "individual contribution index" were obtained. Parameter values were compared between the WMH and HC groups. The performance of the parameters in discriminating between the two groups was assessed using the area under the receiver operating characteristic curve (AUC). The correlation between the individual contribution index and Fazekas score was assessed, and the interaction between age and individual contribution index was determined. A generalized linear model was fitted with the individual contribution index as the dependent variable and the mean standardized uptake value (SUV_mean) of nodes in the whole-brain network or seven classic functional networks as independent variables to determine their association. Results: The means ± standard deviations of the individual contribution index were (0.697 ± 10.9) × 10^-3 and (0.0967 ± 0.0545) × 10^-3 in the WMH and HC groups, respectively (p < 0.001). The AUC of the individual contribution index was 0.864 (95% confidence interval, 0.785-0.943). A positive correlation was identified between the individual contribution index and the Fazekas scores in patients with WMHs (r = 0.57, p < 0.001). Age and individual contribution index demonstrated a significant interaction effect on the Fazekas score. A significant direct association was observed between the individual contribution index and the SUV_mean of the limbic network (p < 0.001). Conclusion: The individual contribution index may demonstrate the redistribution of the brain metabolic network in patients with WMHs.

• 대한치매학회지
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• 제17권3호
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• pp.120-129
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• 2018

Background and Purpose: Prospective memory (PM) has a known relationship with frontal function, and PM decline has been observed in amnestic mild cognitive impairment (aMCI). Cerebral small vessel disease, as evidenced by white matter hyperintensities (WMHs), is linked to frontal dysfunction. This study was undertaken to evaluate the relationship between PM decline and WMHs in patients with aMCI. Methods: Of 74 enrollees with aMCI, 69 completed this prospective study. We compared total scores and sub-scores of the Prospective and Retrospective Memory Questionnaire (PRMQ) administered at baseline and 3 months later, stratifying patients by degree of WMHs. Results: A significant decline was seen in PRMQ total scores and PM scores at the 3-month mark in patients with moderate (vs. mild) degrees of WMHs ($-2.8{\pm}7.2$ vs. $0.2{\pm}7.1$; p=0.032). In addition, patients with moderate (vs. mild) degrees of deep WMHs (DWMHs) showed greater PM decline, whereas PM loss in patients with mild, moderate, or severe degrees of periventricular WMHs (PVWMHs) did not differ significantly. Conclusions: Findings of this study indicate that the burden of WMHs is consistently implicated in PM deterioration experienced by patients with aMCI, and signifies greater PM decline, especially in instances of extensive DWMHs. Greater attention to the change of PM is therefore needed in aMCI patients with WMHs.

• 정신신체의학
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• 제26권2호
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• pp.119-126
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• 2018

연구목적 본 연구의 목적은 알츠하이머병 및 경도인지장애 환자에서 백질고강도신호 차이에 따른 신경인지 기능 및 행동심리증상(BPSD)을 비교하는 것이다. 방 법 본 연구는 후향적 연구로서, 알츠하이머병 및 경도인지장애로 진단받은 115명을 대상으로 하였다. 뇌 자기공명영상의 백질 고강도 신호(white matter hyperintensity, WMH)는 표준화된 시각 기반 척도(Fazekas scales)에 의해 평가되었으며, 참가자들은 Fazekas 척도에 따라 두 그룹으로 분류되었다. 신경인지기능은 임상치매평가척도(CERAD-K)에 의해, BPSD는 한국형 신경정신행동검사(K-NPI)로 평가되었다. WMH의 심각도에 따른 신경인지기능 및 BPSD의 차이를 분석하기 위해 독립표본 t-test를 시행하였다. 결 과 WMH의 중증도가 높은 군은 유의하게 낮은 언어 유창성을 나타내었다(p<0.05). 또한 WMH의 중증도가 높은 군은 유의하게 높은 K-NPI 점수를 보였다(p<0.01). 결 론 WMH와 실행기능과 관련된 신경인지검사 간에는 유의한 연관이 있었다. 또한 WMH는 BPSD의 중증도에 영향을 미치는 것으로 보인다. 임상실제에서 WMH를 알츠하이머 병(Alzheimer's disease, AD)및 경도인지장애(Mild cognitive impairment, MCI)환자를 치료하는데 유용한 정보를 제공할 것이다.

• 생물정신의학
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• 제20권3호
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• pp.97-103
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• 2013

Objectives We aimed to identify the neuroimaging marker for prediction of the use of atypical antipsychotics (AAP) in dementia patients. Methods From April 2010 to March 2013, 31 patients who were diagnosed as dementia at the psychiatric department of Soonchunhyang University Hospital, completed the brain magnetic resonance imaging scan and cognitive test for dementia. Ten patients were treated with AAP for the improvement of behavioral and psychological symptoms of dementia (BPSD) and the other 21patients were not. Using T1 weighted and Fluid Attenuated Inversion Recovery (FLAIR) images of brain, areas of white matter (WM), gray matter (GM), cerebrospinal fluid (CSF) and white matter hyperintensities (WMH) have been segmented and measured. Multivariate logistic regression models were applied for assessment of association between AAP use and the GM/WM ratio, the WMH/whole brain (GM + WM + CSF) ratio. Results There was a significant association between AAP use and the GM/WM ratio (odds ratio, OR = 1.18, 95% confidence interval, CI 1.01-1.38, p = 0.037), while there was no association between AAP use and the WMH/whole brain ratio (OR = 0.82, 95% CI 0.27-2.48, p = 0.73). Conclusions The GM/WM ratio could be a biological marker for the prediction of AAP use and BPSD in patients with dementia. It was more likely to increase as dementia progress since atrophy of WM was more prominent than that of GM over aging.

• Journal of Korean Neurosurgical Society
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• 제46권1호
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• pp.38-44
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• 2009

Objective : The authors studied the risk factors of silent cerebral microbleeds (MBs) and old hematomas (OHs) and their association with concurrent magnetic resonance (MR) imaging findings in the patients of intracerebral hemorrhages (ICHs). Methods : From April 2002 to June 2007, we retrospectively studied 234 patients of primary hemorrhagic stroke. All patients were evaluated with computed tomography (CT) and 3.0-tesla MR imaging studies within the first week of admission. MBs and OHs were assessed by using $T2^{\ast}$-weighted gradient-echo (GRE) MR imaging. The patients were divided into 2 groups, depending on whether or not they had two GRE lesions of chronic hemorrhages. A correlation between MBs and OHs lesions were also statistically tested. Lacunes and white matter and periventricular hyperintensities (WMHs, PVHs) were checked by T1- and T2-weighted spin-echo and fluid attenuated inversion recovery sequences. Variables on the clinical and laboratory data and MR imaging abnormalities were compared between both groups with or without MBs and OHs. Results : MBs were observed in 186 (79.5%) patients and a total of 46 OHs were detected in 45 (19.2%) patients. MBs (39.6%), OHs (80.4%), and ICHs (69.7%) were most commonly located in the ganglionic/thalamic region. Both MBs and OHs groups were more frequently related to chronic hypertension and advanced WMHs and PVHs. The prevalence and number of MBs were more closely associated with OHs groups than non-OH patients. Conclusion : This study clearly demonstrated the presence of MBs and OHs and their correlation with hypertension and cerebral white matter microangiopathy in the ICHs patients. Topographic correlation between the three lesions (MBs, OHs, and ICHs) was also noted in the deep thalamo-basal location.

• Clinical and Experimental Pediatrics
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• 제61권2호
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• pp.64-67
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• 2018

We report the case of a 12-year-old girl who had mild encephalopathy with a reversible splenial lesion (MERS) associated with acutepyelonephritis caused by Escherichia coli. The patient was admitted with a high fever, and she was diagnosed with acute pyelonephritis based on pyuria and the results of urine culture, which detected cefotaxime-sensitive E. coli. Although intravenous cefotaxime and tobramycin were administered, her fever persisted and her C-reactive protein level increased to 307 mg/L. On day 3 of admission, she demonstrated abnormal neuropsychiatric symptoms, such as delirium, ataxia, and word salad. Magnetic resonance imaging (MRI) of the brain performed on day 4 showed marked hyperintensities in the bilateral corpus callosum and deep white matter on diffusion-weighted images, with corresponding diffusion restriction on apparent diffusion coefficient mapping. No abnormalities or pathogens were detected in the cerebrospinal fluid; however, lipopolysaccharides (LPS, endotoxin) were detected in plasma (41.6 pg/mL), associated with acute neurological deterioration. Her clinical condition gradually improved, and no neurological abnormalities were observed on day 6. Follow-up brain MRI performed 2 weeks later showed near-disappearance of the previously noted hyperintense lesions. In this patient, we first proved endotoxemia in a setting of MERS. The release of LPS following antibiotic administration might be related to the development of MERS in this patient. The possibility of MERS should be considered in patients who present with acute pyelonephritis and demonstrate delirious behavior.