Publications by authors named "Joanna Bladowska"

66 Publications

Opsoclonus-myoclonus syndrome with severe clinical course and beneficial outcome: A case report.

Medicine (Baltimore) 2021 Apr;100(14):e25261

Department of Neurology.

Rationale: Opsoclonus-myoclonus syndrome (OMS) is a rare immune-mediated movement disorder, mostly of paraneoplastic or idiopathic origin. The disease usually has an acute onset, serious course and leads rapidly to disability in adult patients. To the best of our knowledge, this is the fourth presented case of OMS with a severe course and complete reversibility of neurological symptoms in a pregnant woman. This report includes videos and a literature review.

Patient Concerns: A 30-year-old woman in the 12th week of pregnancy developed severe nausea and vomiting, after several days balance and gait disorders appeared. On admission to hospital, neurological examination revealed opsoclonus, dysarthria, myoclonic jerks with ataxia of the trunk and limbs with inability to sit, stand or walk.

Diagnosis: Well-known causes of OMS were excluded. Although in our patient the idiopathic origin of the disorder was taken under consideration, diagnosis of opsoclonus-myoclonus related to the pregnancy was highly likely.

Interventions: After administration of steroids and benzodiazepines the patient improved.

Outcomes: In the 6th month of pregnancy, after termination of immunotherapy, she recovered completely and was able to sit, stand and walk independently. In the 39th week of pregnancy, she delivered a healthy child.

Lessons: We confirm that understanding of clinical symptoms and rare causes of OMS contributes to early diagnosis and therapy, which ensures an optimal outcome. One probable cause of OMS could be a physiological change to immune system regulation during pregnancy. The relationship between OMS and pregnancy remains uncertain and needs further investigation.
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http://dx.doi.org/10.1097/MD.0000000000025261DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8036019PMC
April 2021

The evaluation of Hashimoto's thyroiditis with event-related potentials and magnetic resonance spectroscopy and its relation to cognitive function.

Sci Rep 2021 Jan 28;11(1):2480. Epub 2021 Jan 28.

Department of Neurology, Wroclaw Medical University, Wroclaw, Poland.

Thyroid dysfunction is very often accompanied by cognitive and affective disorders. The frequency of these disorders in patients with compensated Hashimoto's thyroiditis (HT) is unknown. The aim of the present study was to evaluate brain dysfunction in euthyroid HT patients by means of event-related potentials (ERP) and magnetic resonance spectroscopy (MRS) and to correlate it with cognitive function. 68 patients with HT (59 female, 9 male) and 45 healthy controls were included in the study. All the patients underwent ERP including an analysis of N200 and P300 response parameters. MRS voxels were located in the posterior cingulate gyrus (PCG) and the left parietal white matter (PWM). The NAA/Cr, mI/Cr, and Cho/Cr ratios were analysed. The ERP parameters, MRS metabolite ratios and hormonal concentrations (TSH, fT3, fT4) as well as TGAb and TPOAb titer were also correlated. There was a significant prolongation of the latencies of N200 and P300 potentials and a significant decrease of P300 amplitude in HT patients than in the control group. There was a significant positive correlation between the mI/Cr ratio in the PCG area and P300 latencies. NAA/Cr ratio in the PCG region showed significant negative correlations with all N200 latencies. The results may suggest brain dysfunction in neurologically asymptomatic HT patients. ERPs undergo significant changes in patients with HT and may, in combination with MRS, constitute an important element in the recognition and monitoring of cognitive functions in this group of patients.
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http://dx.doi.org/10.1038/s41598-021-82281-6DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7843607PMC
January 2021

A Review of Neuroimaging in Rare Neurodegenerative Diseases.

Dement Geriatr Cogn Disord 2020 28;49(6):544-556. Epub 2021 Jan 28.

Department of General and Interventional Radiology and Neuroradiology, Wroclaw Medical University, Wroclaw, Poland.

Purpose: Due to the variety of clinical symptoms that occur in rare neurodegenerative diseases and difficulties in the correct diagnosis, there is a need to learn their characteristic imaging findings by using conventional MRI. That knowledge helps to determine the appropriate differential diagnosis and avoid misdiagnosis. The aim of this review is to present the typical neuroimaging signs of the selected neurodegenerative disorders and to create a practical approach to imaging findings useful in everyday clinical practice. Images: Images of progressive supranuclear palsy (PSP), multiple system atrophy (MSA), corticobasal degeneration (CBD), Creutzfeldt-Jakob disease (CJD), Wilson's disease (WD), and cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL) are provided to visualize and distinguish the typical features of those diseases and therefore to assist neurologists and neuroradiologists in decision-making process.

Conclusions: It is important to know the characteristic MRI features of rare neurodegenerative diseases and to use them in everyday clinical practice. MRI is a valuable tool when considering the initial diagnosis because it is proven to be very useful in the differentiation of more advanced stages of the rare neurodegenerative diseases but also from other neurodegenerative disorders.
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http://dx.doi.org/10.1159/000512543DOI Listing
January 2021

Easily missed or misinterpreted: diabetic striatopathy in the course of ketotic hyperglycaemia.

Postgrad Med J 2021 Jan 13. Epub 2021 Jan 13.

General and Interventional Radiology and Neuroradiology, Wroclaw Medical University, Wroclaw, Dolnoslaskie, Poland.

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http://dx.doi.org/10.1136/postgradmedj-2020-139499DOI Listing
January 2021

Magnetic resonance spectroscopy of the normal appearing grey matter in the posterior cingulate gyrus in the prognosis and monitoring of disease activity in MS patients treated with interferon-β in a 3-year follow-up.

J Clin Neurosci 2020 Sep 6;79:205-214. Epub 2020 Aug 6.

Department of General and Intervantional Radiology and Neuroradiology, Wroclaw Medical University, ul. Borowska 213, 50-556 Wrocław, Poland.

Several predictors of non-response to interferon-β (IFN-β) treatment have been proposed. The aim of the study was to identify metabolite changes in the normal-appearing cortex of the posterior cingulate gyrus (PCG) using MRS (magnetic resonance spectroscopy) and to investigate their usefulness in prognosis of NEDA (no evidence of disease activity) in the 3-year follow-up and in monitoring treatment effects during IFN-β therapy in the parallel period of time in multiple sclerosis (MS) patients. Forty-one relapsing-remitting MS patients and 41 sex- and age-matched healthy subjects underwent routine MRI protocol with MRS sequence with the use of a 1.5 T magnet. A single voxel size of 2x2x2cm was inserted in the cortex of PCG region. Associations between baseline metabolic ratios, conventional MRI findings, demographic and clinical factors, and NEDA status were evaluated using logistic, Cox, and multinomial logistic regression models. MS patients in the initial scan showed a statistically significant decline in NAA/Cr ratio (p < 0.0001) and an increase in Cho/Cr ratio (p = 0.016) compared to the control group. None of the MRS parameters predicted NEDA maintenance or the time to loss of NEDA. In treatment monitoring only an improvement in the combination of NAA/Cr + Cho/Cr ratio between the 1st and 2nd year of treatment was connected with a 6.27-fold chance (p = 0.025) of having simultaneous NEDA maintenance. To conclude, metabolite alterations in the PCG region did not predict NEDA maintenance, but they seem to be useful in treatment monitoring.
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http://dx.doi.org/10.1016/j.jocn.2020.07.045DOI Listing
September 2020

The role of ADC values within the normal-appearing brain in the prognosis of multiple sclerosis activity during interferon-β therapy in the 3-year follow-up: a preliminary report.

Sci Rep 2020 07 30;10(1):12828. Epub 2020 Jul 30.

Department of General and Interventional Radiology and Neuroradiology, Wroclaw Medical University, 213 Borowska Street, 50-556, Wroclaw, Poland.

Predictors of multiple sclerosis (MS) activity during disease-modifying treatment are being extensively investigated. The aim of this study was to assess the prognosis of NEDA (no evidence of disease activity) status during IFN-β (interferon-β) treatment, using apparent diffusion coefficient (ADC) measurements obtained at initial MRI (magnetic resonance imaging). In 87 MS patients treated with IFN-β, ADC values were calculated for 13 regions of normal-appearing white and grey matter (NAWM, NAGM) based on MRI performed with a 1.5 T magnet before (MS0, n = 45) or after one year of therapy (MS1, n = 42). Associations were evaluated between ADC, conventional MRI findings, demographic and clinical factors and NEDA status within the following 3 years using logistic, Cox and multinomial logistic regression models. NEDA rates in the MS0 group were 64.4%, 46.5% and 33.3% after the 1st, 2nd and 3rd year of treatment, respectively and in MS1 patients 71.4% and 48.7% for the periods 1st-2nd and 1st-3rd years of treatment, respectively. ADC values in the NAWM regions contributed to loss of NEDA and its clinical and radiological components, with a 1-3% increase in the risk of NEDA loss (p = 0.0001-0.0489) in both groups. ADC measurements may have an additional prognostic value with regard to NEDA status.
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http://dx.doi.org/10.1038/s41598-020-69383-3DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7393067PMC
July 2020

Severe, Reversible Acute Lung Injury During Autologous Hematopoietic Stem Cell Mobilization After Filgrastim in a Child With Neuroblastoma: A Case Report.

Transplant Proc 2020 Nov 23;52(9):2849-2853. Epub 2020 Jul 23.

Department of Pediatric Bone Marrow Transplantation, Oncology, and Hematology, Wroclaw Medical University, Wroclaw, Poland. Electronic address:

Peripheral blood hematopoietic stem cell mobilization is widely performed in a variety of clinical facilities and is believed to be a safe outpatient procedure. In this report, we describe a child with neuroblastoma who developed an extremely severe acute lung injury after granulocyte colony-stimulating factor was used for peripheral hematopoietic stem cell mobilization. A 3-year-old boy with a medical history of patent foramen ovale and secundum atrial septal defect was diagnosed with an MYCN-amplified neuroblastoma and treated with chemotherapy. During stem cell mobilization with filgrastim, the boy was in very good clinical condition, with a peripheral white blood cell (WBC) count of 57.17 K/μL, but he suddenly deteriorated, and nausea, seizures, and nystagmus were observed. The patient developed dyspnea with hemoptysis, and lung computed tomography showed bilateral asymmetrical pulmonary opacification demonstrating an anteroposterior density gradient. Because of rapidly progressing circulatory and respiratory failure, the child was hospitalized in the intensive care unit. Corticosteroid therapy, broad-spectrum antibiotic therapy, and cardiovascular support with mechanical ventilation were immediately instituted, and the child recovered without sequelae. The presented case emphasizes that life-threatening complications can occur during granulocyte colony-stimulating factor administration, and patient surveillance is warranted, especially if high leukocyte counts are observed or the patient exhibits cardiopulmonary signs.
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http://dx.doi.org/10.1016/j.transproceed.2020.06.027DOI Listing
November 2020

Transient Global Amnesia - Risk Factors and Putative Background.

Neurol India 2020 May-Jun;68(3):624-629

Department of Neurology, Interventional Radiology and Neuroradiology, Wroclaw Medical University, Poland.

Objectives: Transient global amnesia (TGA) is a temporary short-term reversible memory loss. Etiology of TGA remains unclear with various hypotheses. We analyzed clinical characteristics, neuroimaging, and electrophysiological findings as well as comorbidities and seasonal variation in TGA patients with regard to possible background of the syndrome.

Materials And Methods: A total of 56 patients (42 women and 14 men) with TGA hospitalized from 2008 to 2016 in the Department of Neurology, Wrocław Medical University.

Results: A total of 52 patients (92.9%) underwent their first-ever episode of TGA. The potential triggers or events before episode could be recognized in 22 patients (39.3%). 35.7% patients had TGA in summer and 26.8% in winter months. In 92.9% patients chronic diseases were found, included: Hypertension (60.7%), dyslipidemia (48.2%), autoimmune thyroiditis (17.9%), and ischemic heart disease (14.3%). One patient (1,8%) suffered from migraine. Doppler ultrasonography of carotid arteries revealed abnormalities in 29 patients (51.8%). Electroencephalography abnormalities were observed in 10 (17.6%) of patients.

Conclusion: Our findings suggest a putative cerebrovascular background of transient global amnesia. No evidence has been provided for the association between TGA and epilepsy or migraine. Among comorbidities, autoimmune thyroiditis deserves further investigation with regard to its potential links with TGA.
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http://dx.doi.org/10.4103/0028-3886.288979DOI Listing
July 2020

Developmental Venous Anomaly Thrombosis: Mimicking a Cortical Brain Tumor.

Eur Neurol 2020 26;83(2):222-224. Epub 2020 May 26.

Department of General and Interventional Radiology and Neuroradiology, Wroclaw Medical University, Wroclaw, Poland.

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http://dx.doi.org/10.1159/000507574DOI Listing
May 2020

Diffusion tensor imaging of normal-appearing cervical spinal cords in patients with multiple sclerosis: Correlations with clinical evaluation and cerebral diffusion tensor imaging changes. Preliminary experience.

Adv Clin Exp Med 2020 Apr;29(4):441-448

Department of General Radiology, Interventional Radiology and Neuroradiology, Wroclaw Medical University, Poland.

Background: Several studies have identified changes in the spinal cord DTI measurements in patients with multiple sclerosis (MS). However, correlations between changes in DTI parameters in normal appearing cervical spine and neurological findings have not been clearly established.

Objectives: To determine whether diffusion tensor imaging (DTI) measurements such as fractional anisotropy (FA) and apparent diffusion coefficient (ADC) are sufficiently sensitive in detecting microstructure alterations in normal-appearing spinal cords in patients with MS and whether they reflect these patients' clinical disability.

Material And Methods: Fifteen patients diagnosed with relapsing-remitting MS (RRMS) with normal-appearing cervical spinal cords on plain MRI and 11 asymptomatic volunteers were enrolled in the study. Overall, 75 cervical spinal segments were analyzed. The regions of interest were drawn from the entire spinal cord cross-section and in the normal-appearing white matter tracts: the superior and inferior cerebellar peduncles and the posterior limbs of the internal capsules. Neurological deficit and the level of disability were evaluated using the Expanded Disability Status Scale (EDSS), the timed 25-foot walk test (T25FW) and the 9-hole peg test (9HPT) for manual dexterity.

Results: A significant difference (p < 0.05) in FA values between patients with MS and the control group was found at levels C2 (p = 0.047) and C3 (p = 0.023). No significant changes in ADC values were found. There was correlation between FA and ADC values in selected white matter tracts and at particular spinal cord levels. We also observed significant correlations between diffusion tensor imaging parameters and manual dexterity.

Conclusions: Our preliminary results may suggest that the spinal cord's structural loss is the dominant factor in the inflammatory/demyelinating component in patients with MS. Diffusion tensor imaging changes in the spinal cord correlate with brain DTI changes. Manual functioning seems to be more affected than walking.
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http://dx.doi.org/10.17219/acem/116754DOI Listing
April 2020

Acromegaly due to ectopic growth hormone-releasing hormone secretion by lung carcinoid.

Pol Arch Intern Med 2020 08 1;130(7-8):685-687. Epub 2020 May 1.

Department of Endocrinology, Diabetes and Isotope Therapy, Wroclaw Medical University, Wrocław, Poland

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http://dx.doi.org/10.20452/pamw.15337DOI Listing
August 2020

Susac's Syndrome.

Neurol India 2019 Jul-Aug;67(4):1168

Department of Clinical Neurology, Wroclaw Medical University, Wroclaw, Poland.

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http://dx.doi.org/10.4103/0028-3886.266278DOI Listing
October 2020

Imaging of cerebrospinal fluid flow: fundamentals, techniques, and clinical applications of phase-contrast magnetic resonance imaging.

Pol J Radiol 2019 13;84:e240-e250. Epub 2019 May 13.

Department of General and Interventional Radiology and Neuroradiology, Wroclaw Medical University, Wroclaw, Poland.

Cerebrospinal fluid (CSF) is a dynamic compartment of the brain, constantly circulating through the ventricles and subarachnoid space. In recent years knowledge about CSF has expended due to numerous applications of phase-contrast magnetic resonance imaging (PC-MRI) in CSF flow evaluation, leading to the revision of former theories and new concepts about pathophysiology of CSF disorders, which are caused either by alterations in CSF production, absorption, or its hydrodynamics. Although alternative non-invasive techniques have emerged in recent years, PC-MRI is still a fundamental sequence that provides both qualitative and quantitative CSF assessment. PC-MRI is widely used to evaluate CSF hydrodynamics in normal pressure hydrocephalus (NPH), Chiari type I malformations (CMI), syringomyelia, and after neurosurgical procedures. In NPH precisely performed PC-MRI provides reliable clinical information useful for differential diagnosis and selection of patients benefiting from surgical operation. Patients with CMI show abnormalities in CSF dynamics within the subarachnoid space, which are pronounced even further if syringomyelia coexists. Another indication for PC-MRI may be assessment of post-surgical CSF flow normalisation. The aim of this review is to highlight the significance of CSF as a multifunctional entity, to outline both the physical and technical background of PC-MRI, and to state current applications of this technique, not only in the diagnosis of central nervous system disorders, but also in the further clinical monitoring and prognosis after treatment.
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http://dx.doi.org/10.5114/pjr.2019.86881DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6717940PMC
May 2019

Quantitative magnetic resonance assessment of brain atrophy related to selected aspects of disability in patients with multiple sclerosis: preliminary results.

Pol J Radiol 2019 2;84:e171-e178. Epub 2019 Apr 2.

Department of General Radiology, Interventional Radiology and Neuroradiology, Wroclaw Medical University, Poland.

Purpose: The aim of this volumetric study was to evaluate the relationship between brain atrophy quantification in multiple sclerosis (MS) patients and the progression of disability measured by neurological standardised tests.

Material And Methods: Seventeen patients (mean age 40.89 years) with clinically definite MS and 24 control subjects (mean age 38.45 years) were enrolled in the study. Brain examinations were performed on a 1.5T MR scanner. Automatic brain segmentation was done using FreeSurfer. Neurological disability was assessed in all patients in baseline and after a median follow-up of two years, using EDSS score evaluation.

Results: In MS patients we found significantly ( < 0.05) higher atrophy rates in many brain areas compared with the control group. The white matter did not show any significant rate of volume loss in MS patients compared to healthy controls. Significant changes were found only in grey matter volume in MS subjects. At the follow-up evaluation after two years MS patients with deterioration in disability revealed significantly decreased cerebral volume in 14 grey matter areas at baseline magnetic resonance imaging (MRI) compared to MS subjects without disability progression.

Conclusions: Grey matter atrophy is associated with the degree of disability in MS patients. Our results suggest that morphometric measurements of brain volume could be a promising non-invasive biomarker in assessing the volumetric changes in MS patients as related to disability progression in the course of the disease.
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http://dx.doi.org/10.5114/pjr.2019.84274DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6717938PMC
April 2019

Navigated neuroendoscopy combined with intraoperative magnetic resonance cysternography for treatment of arachnoid cysts.

Neurosurg Rev 2020 Aug 16;43(4):1151-1161. Epub 2019 Jul 16.

Department of Neurosurgery, University Hospitals of Birmingham, Birmingham, UK.

Endoscopic cystocysternostomy or cystoventriculostomy is the treatment of choice in patients with symptomatic intracranial arachnoid cysts. There are no objective diagnostic tests for reliable intraoperative evaluation of the effectiveness of performed stomies. The aim of this prospective open-label study is to demonstrate for the first time the usefulness of intraoperative cysternography performed with the low-field 0.15-T magnetic resonance imager Polestar N20 during endoscopic cysternostomies. The study was performed in patients operated for middle fossa arachnoid cysts (n = 10), suprasellar cysts (n = 4), paraventricular or intraventricular cysts (n = 6), and a pineal cyst (n = 1). The operations were performed with use of a navigated neuroendoscope. Intraoperative magnetic resonance (iMR) cysternography was performed before and after the cystostomy. In each case, iMR cysternography was safe and could show clearly the cyst morphology and the effectiveness of performed endoscopic cystostomies. In six cases, iMR cysternography had a significant influence of the surgical decision (p = 0.027). The rate of inconsistency between the intraoperative observations and iMR imaging-based findings was 29%. A good contrast flow through the fenestrated cyst walls correlated with a good long-term clinical outcome (ρ = 0.54, p < 0.05) and good long-term radiological outcome (ρ = 0.72, p < 0.05). Intraoperative low-field MR cysternography is a safe and reliable method for assessment of the efficacy of performed endoscopic cystostomies and has significant influence on the surgical decision. It may be reliably used for prediction of the long-term clinical and radiological outcome.
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http://dx.doi.org/10.1007/s10143-019-01136-xDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7347696PMC
August 2020

Bilateral thalamic stroke after tonsillectomy in a patient with collateral extracranial anastomosis - case report.

Pol J Radiol 2019 18;84:e126-e130. Epub 2019 Feb 18.

Department of General and Interventional Radiology and Neuroradiology, Wroclaw Medical University, Wroclaw, Poland.

Haemorrhage remains the most frequent and serious complication of tonsillectomy. When bleeding is recurrent, gushing, and ceases spontaneously, pseudoaneurysm of the injured artery in the proximity of the tonsillar bed should be suspected. Haemorrhage related to pseudoaneurysm occurs most commonly in the first 30 days after surgery. It can sometimes be excessive and requires a revision procedure such as external carotid artery (ECA) ligation or embolisation. During those procedures, ECA should be checked for possible anastomoses, otherwise the bleeding may persist despite the intervention. We report an unusual case of a patient with recurrent post-tonsillectomy haemorrhage due to pseudoaneurysm of the facial artery, which persisted after ECA ligation because of the presence of collateral occipital-vertebral anastomosis. Due to the recurrence of bleeding episodes, endovascular treatment was implemented. However, the embolisation was complicated by bilateral thalamic stroke with unclear mechanism. This case highlights the importance of anastomosis between ECA and the vertebrobasilar system, both in recurrence of significant post-tonsillectomy bleeding and in potential thromboembolic complications. Therefore, ECA ligation should always be accompanied by exclusion of possible anastomoses. In cases of non-life-threatening bleeding, embolisation seems to be the proper and more selective therapy.
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http://dx.doi.org/10.5114/pjr.2019.83004DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6479139PMC
February 2019

A pictorial essay of the most atypical variants of the vermiform appendix position in computed tomography with their possible clinical implications.

Pol J Radiol 2019 4;84:e1-e8. Epub 2019 Jan 4.

Department of General and Interventional Radiology and Neuroradiology, Wroclaw Medical University, Wroclaw, Poland.

Purpose: The tip of the appendix may be located in various areas of the abdominal cavity due to its variable length and/or the changeable position of the caecum. Although in the case of an atypical position the tip is usually located behind the caecum, there are possible locations that occur very rarely. Therefore, in the case of appendicitis the symptoms may lead to the wrong diagnosis. The aim of this study is to present the most atypical locations of the tip of the appendix found on CT (computed tomography) scans and thus help to avoid misdiagnoses.

Imaging Findings: The most unusual locations of the tip of the appendix found in healthy subjects included: left inferior quadrant, along the lower edge of the liver near the gallbladder and the right kidney, the tip touching the duodenum, the rectum or appendages, and a long appendix located in the scrotum as the content of a hernia. In these positions, appendicitis may mimic acute diverticulitis, cholecystitis, duodenal ulcer, duodenitis, enteritis, or adnexal or testis pathologies.

Conclusions: It is important to be aware of atypical locations of the appendix because appendicitis in an unusual area may mimic other acute abdominal diseases and delay the proper treatment.
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http://dx.doi.org/10.5114/pjr.2018.81158DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6479055PMC
January 2019

The Usefulness of Quantitative EEG and Advanced MR Techniques in the Monitoring and Long-Term Prognosis of Lance-Adams Syndrome.

Front Neurol 2019 12;10:214. Epub 2019 Mar 12.

Department of Neurology, Wroclaw Medical University, Wroclaw, Poland.

Chronic post-hypoxic myoclonus, known as Lance-Adams syndrome (LAS), is a rare complication of successful cardiopulmonary resuscitation. It is characterized by intention myoclonus, cerebellar ataxia, and preserved intellect. The basis of the disease and its long-term prognosis remain unclear. The authors present a 53-year-old woman with a history of asthma bronchiale who suffered from myoclonus after hypoxic brain damage due to cardiac arrest. Advanced electrophysiological (quantitative EEG) and MR (MR spectroscopy) techniques were employed. Over long-term observation the results suggested permanent synaptic rearrangements of the neuronal networks due to brain plasticity in the patient after the brain hypoxia.
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http://dx.doi.org/10.3389/fneur.2019.00214DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6422875PMC
March 2019

Evaluation of brain volume alterations in HCV-infected patients after interferon-free therapy: A pilot study.

J Neurol Sci 2019 Apr 7;399:36-43. Epub 2019 Feb 7.

Department of General Radiology, Interventional Radiology and Neuroradiology, Radiology, Wroclaw Medical University, Borowska 213, 50-556 Wroclaw, Poland.

The study was performed to evaluate cerebral volume changes in HCV-infected subjects before and after interferon-free therapy with direct-acting antiviral agents (DAA). We aimed also to estimate the impact of successful DAA therapy on the neuropsychological state of patients. Eleven HCV genotype 1 (GT1) patients treated with ombitasvir/paritaprevir (boosted with ritonavir) and dasabuvir, with or without ribavirin underwent brain magnetic resonance (MR) before and 24 weeks after completion of therapy. All patients achieved sustained viral response. Precise automatic parcellation was made using the fully-available software FreeSurfer 6.0. Statistically significant volume deceleration six months after treatment was found in the subcallosal cingulate gyrus, transverse frontopolar gyri and sulci, anterior segment of the circular sulcus of the insula and horizontal ramus of the anterior segment of the lateral sulcus. After DAA therapy we found statistically significant improvement in the performance of all three tasks of the Rey Complex Figure Test that permits the evaluation of different functions (attention, planning, working,memory). Additionally, significant amelioration in Percentage Conceptual Level Responses in The Wisconsin Card Sorting Test (a neurocognitive test for assessing intellectual functioning) was also discovered. Successful interferon-free therapy may lead to transient cerebral atrophy, probably by reducing neuroinflammation and oedema. This is the first pilot study of the alterations in brain volume after successful interferon-free therapy in chronic HCV patients. Longitudinal follow-up study is needed to observe further effects of therapy on cerebral structures volume changes.
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http://dx.doi.org/10.1016/j.jns.2019.02.002DOI Listing
April 2019

The role of MR volumetry in brain atrophy assessment in multiple sclerosis: A review of the literature.

Adv Clin Exp Med 2019 07;28(7):989-999

Department of General Radiology, Interventional Radiology and Neuroradiology, Wroclaw Medical University, Poland.

We review the current role of magnetic resonance (MR) volumetry as a meaningful indicator of neurodegeneration and clinical disease progression in multiple sclerosis (MS) patients. Based on a review of the current literature we summarize the mechanisms that contribute to brain atrophy. We present the newest magnetic resonance imaging (MRI)-based methods used in atrophy quantification. We also analyze important biological factors which can influence the accuracy of brain atrophy evaluation. Evidence shows that measures of brain volume (BV) have the potential to be an important determinant of disease progression to a greater extent than conventional lesion assessment. Finally, scientific reports concerning limitations of MRI-based volumetry that affect its implementation into routine clinical practice are also reviewed. The technical challenges that need to be overcome include creating a standardized protocol for image acquisition - a fully automated, accurate and reproducible method that allows comparison in either single-center or multicenter settings. In the near future, quantitative MR research will probably be the basic method used in neurology to monitor the rate of atrophic processes and clinical deterioration in MS patients, and to evaluate the results of treatment.
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http://dx.doi.org/10.17219/acem/94137DOI Listing
July 2019

Interferon-free therapy as the cause of white matter tracts and cerebral perfusion recovery in patients with chronic hepatitis C.

J Viral Hepat 2019 06 27;26(6):635-643. Epub 2019 Feb 27.

Department of General Radiology, Interventional Radiology and Neuroradiology, Wroclaw Medical University, Wroclaw, Poland.

The purpose of this study was to assess cerebral microstructural and perfusion changes in patients with chronic hepatitis C virus (HCV) infection before and after interferon-free therapy, using advanced magnetic resonance (MR) techniques. Eleven HCV-positive patients underwent diffusion tensor imaging (DTI) and perfusion-weighted imaging (PWI) using a 1.5T MR unit, before and 24 weeks after completion of interferon-free therapy. DTI fractional anisotropy (FA) and apparent diffusion coefficient (ADC) values were obtained from 14 white matter tracts. PWI values of relative cerebral blood volume (rCBV) and relative cerebral blood flow (rCBF) were assessed from 8 areas, including basal ganglia, and cortical and white matter locations. In HCV-positive patients therapy with ombitasvir, paritaprevir boosted with ritonavir and dasabuvir, with or without ribavirin, was scheduled. Cognitive tests were used to assess cognitive function. We found increased FA values after interferon-free therapy compared to values obtained before treatment in HCV patients in almost all white matter tracts. We also observed elevated rCBV values in basal ganglia after therapy. There were significant correlations between improvement in the score of cognitive tests and increased FA values in both inferior fronto-occipital fascicles and left posterior cingulum after treatment. Liver fibrosis regression in elastography, APRI and improvement in cognitive tests were observed. This is the first report of interferon-free therapy as the cause of white matter tracts recovery as well as cerebral perfusion improvement in HCV-infected patients, indicating better functioning of frontal lobes after interferon-free treatment.
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http://dx.doi.org/10.1111/jvh.13069DOI Listing
June 2019

Visual and brainstem auditory evoked potentials in HCV-infected patients before and after interferon-free therapy - A pilot study.

Int J Infect Dis 2019 Mar 11;80:122-128. Epub 2019 Jan 11.

Department of Infectious Diseases, Liver Diseases and Acquired Immune Deficiency, Wroclaw Medical University, Koszarowa 5, 51-149 Wroclaw, Poland.

Introduction: The aim of this study was to investigate brain bioelectrical activity disturbances in HCV-positive patients before and 24 weeks after interferon-free therapy (DAA), using visual (VEP) and brainstem (BAEP) evoked potentials and advanced magnetic resonance techniques.

Materials And Methods: 11 HCV-infected patients (6 women, 5 men, mean age 51 years old) and 30 healthy controls, sex and age-matched, were studied. Clinical neurological examinations, VEP, BAEP, diffusion tensor imaging (DTI) and perfusion weighted imaging (PWI) were performed.

Results: 11 patients achieved a sustained viral response, and liver fibrosis regression in APRI and in elastography were observed. The mean P100 latency was significantly shorter in HCV-patients after therapy compared to the values before treatment (p<0.05). The mean wave BAEP V latency and I-V interpeak latency were significantly longer in the HCV-infected patients before therapy compared to HCV-patients after therapy.

Conclusions: This study confirms that treatment with DAA in patients with chronic HCV infection positively affects the bioelectrical activity of the brain. An increase in the amplitude of EP after treatment indicates an improvement in the activity of the cerebral cortex. EP examination may be a useful method of assessing the function of the nervous system before and after antiviral treatment.
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http://dx.doi.org/10.1016/j.ijid.2019.01.011DOI Listing
March 2019

The role of diffusion and perfusion magnetic resonance imaging in differentiation of haemangioblastomas and pilocytic astrocytomas.

Pol J Radiol 2018 10;83:e197-e203. Epub 2018 May 10.

Department of General and Interventional Radiology and Neuroradiology, Wroclaw Medical University, Poland.

Purpose: Haemangioblastomas (HABLs) and pilocytic astrocytomas (PAs) are brain tumours presenting similar appearance and location in conventional magnetic resonance (MR) imaging. The purpose of our study was to determine whether a detailed analysis of diffusion (DWI) and perfusion (PWI) characteristics can be useful in preoperative differentiation of these tumours.

Material And Methods: The study group consisted of biopsy proven six HABLs and six PAs, which underwent preoperative standard MR examinations including PWI and DWI. In PWI relative cerebral blood volume (rCBV) and the shape of perfusion curves (parameters of peak height - rPH and percentage of signal recovery - rPSR) were analysed. All perfusion parameters were measured for the entire tumour core (mean rCBV, mean rPH, mean rPSR) and in regions with maximal values (max rCBV, max rPH, max rPSR). In DWI parameters of apparent diffusion coefficient (ADC) from the entire tumour core (mean ADC) and in regions with minimal values (min ADC) were evaluated.

Results: Compared to PAs, HABLs presented significantly higher rCBV and rPH values and lower mean rPSR value. PAs showed significantly lower rCBV and rPH values and higher mean rPSR value. Mean rCBV showed no overlap in the values between HABLs and PAs, and thus it provided the highest accuracy in differentiating between them. Max rPSR, mean ADC, and min ADC did not show any significant differences.

Conclusions: High rCBV values and deep perfusion curves with only partial return to the baseline are characteristic features of HABLs differentiating them from PAs, which show lower rCBV values and perfusion curves overshooting the baseline. Diffusion parameters are not useful in differentiation of these tumours.
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http://dx.doi.org/10.5114/pjr.2018.75870DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6323599PMC
May 2018

Apparent diffusion coefficient measurements in normal appearing white matter may support the differential diagnosis between multiple sclerosis lesions and other white matter hyperintensities.

J Neurol Sci 2019 02 14;397:24-30. Epub 2018 Dec 14.

Department of General and Interventional Radiology and Neuroradiology, Wroclaw Medical University, ul. Borowska 213, 50-556 Wrocław, Poland.

Aims: The objectives of the study were to assess the usefulness of measurements of apparent diffusion coefficient (ADC) in normal appearing white and grey matter (NAWM, NAGM) in differential diagnosis between patients with hyperintense demyelinating plaques in the course of multiple sclerosis (MS) and other conditions presenting white matter hyperintensities (WMHs), as well as to evaluate the relationship between clinical data and ADC values in MS patients.

Material And Methods: The study comprised 66 patients with MS before treatment, 66 patients with WMHs and 64 control subjects (control group, CG), who underwent MRI (magnetic resonance imaging) examination including diffusion weighted imaging (DWI) with a 1.5 T MR unit. ADC measurements were obtained from NAWM of the cerebellum, pons as well as frontal, fronto-parietal and temporal regions bilaterally, and from NAGM of thalami and heads of caudate nuclei, using round region of interest (ROI) sized 200mm.

Results: The mean ADC values in frontal, fronto-parietal and temporal NAWM were significantly higher in the MS group than in subjects with WMHs and CG (p < .001), whereas the mean ADC value in pons was higher in MS than in CG (p < .05). In the MS group we observed a positive correlation between the Expanded Disability Status Scale (EDSS) and lesion load, between duration of the disease and mean ADC values and between lesion load and mean ADC values.

Conclusion: Our results suggest that ADC measurements may support the differential diagnosis between MS and other conditions associated with white matter hyperintensities. The most significant changes were observed in temporal white matter regions.
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http://dx.doi.org/10.1016/j.jns.2018.12.018DOI Listing
February 2019

The metabolic alterations within the normal appearing brain in patients with Hashimoto's thyroiditis are correlated with hormonal changes.

Metab Brain Dis 2019 02 21;34(1):53-60. Epub 2018 Sep 21.

Department of General Radiology, Interventional Radiology and Neuroradiology, Wrocław Medical University, Wrocław, Poland.

Hashimoto's thyroiditis (HT) is the most common autoimmune disease in humans usually associated with subsequent hypothyroidism. The purpose of the study was to assess metabolic alterations within the normal appearing brain in subjects with HT using MR spectroscopy (MRS) and to correlate MRS measurements with hormonal concentrations. Fifty-five HT patients (mean age 43.5 yrs) and 30 healthy controls (mean age 42.5 yrs) were examined with the use of a 1.5 T MR scanner. There were no signs of central nervous system involvement in the studied group. The MRS examinations were performed using the single voxel method. The voxels were placed in the left parietal white matter (PWM) and the posterior cingulate gyrus (PCG). The NAA/Cr, Cho/Cr, and mI/Cr ratios were calculated. The correlations between metabolite ratios and hormonal concentrations (TSH, fT3, fT4) as well as anti-TG and anti-TPO levels were also assessed. We found significantly (p < 0.05) decreased NAA/Cr ratios in PCG and PWM in HT subjects compared to the control group. There were no other significant differences in metabolite ratios. We observed significant positive correlations between the NAA/Cr ratio in PCG as well as the PWM and fT3 level. There was also a significant negative correlation between the Cho/Cr ratio in the PCG and fT4 level. MRS could be a sensitive biomarker capable of depicting early cerebral metabolic disturbances associated with HT. Our findings may indicate the reduction of neuronal activity within the normal appearing brain in patients with HT as well as suggesting that there is a possible biological association between thyroid dysfunction and cerebral metabolic changes.
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http://dx.doi.org/10.1007/s11011-018-0318-zDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6351519PMC
February 2019

Diagnostic Difficulties in Primary Pauci-Melanotic Leptomeningeal Melanomatosis.

Eur Neurol 2018 19;80(1-2):68-70. Epub 2018 Sep 19.

Department of Pathomorphology and Oncologic Cytology, Wroclaw Medical University, Wroclaw, Poland.

We present a rare case of primary malignant melanoma of the central nervous system. We underline the difficulties we faced during diagnostic procedures. Finally, postmortem examination revealed the diagnosis of primary pauci--melanotic leptomeningeal melanomatosis.
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http://dx.doi.org/10.1159/000493197DOI Listing
January 2019

Metastatic pulmonary calcification as a rare complication of end-stage renal disease with coexistence of pulmonary metastases from renal cell carcinoma: case report and literature review.

Pol J Radiol 2018 1;83:e115-e119. Epub 2018 Apr 1.

Department of General and Interventional Radiology and Neuroradiology, Wrocław Medical University, Wrocław, Poland.

Purpose: We present a case of metastatic pulmonary calcification (MCP) in an asymptomatic patient with chronic kidney disease after renal transplantation and nephrectomy due to renal cancer. Chest computed tomography (CT) revealed bilateral, diffuse, centrilobular ground-glass opacities and heterogeneous, high-density areas distributed throughout the lungs, predominantly in the upper and middle lobes. Unusually, in our patient the metastatic calcification coexisted with pulmonary metastases from renal cell carcinoma associated with end-stage renal disease. To our knowledge, such coexistence has not been previously described.

Case Report: CT, particularly high-resolution chest computed tomography (HRCT), plays an important role in detection and follow-up of MPC findings, which include ground-glass opacities and partially calcified nodules or consolidations, predominantly in the upper lung zones. Correct diagnosis is important because misdiagnosis may lead to improper or unnecessary treatment and/or procedures.

Conclusions: MPC is a rare condition that results from calcium deposition in the normal pulmonary parenchyma. MPC commonly occurs in patients with end-stage chronic kidney disease due to abnormalities in calcium and phosphate metabolism. It is worth pointing out that despite the fact that the condition is called metastatic, it is a relatively benign lung disease with a generally good long-term prognosis.
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http://dx.doi.org/10.5114/pjr.2018.75725DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6047097PMC
April 2018

Diffusion and perfusion MR patterns of central nervous system lymphomas.

Adv Clin Exp Med 2018 Aug;27(8):1099-1108

Department of General and Interventional Radiology and Neuroradiology, Wroclaw Medical University, Poland.

Background: Central nervous system lymphomas (CNSLs) are rare tumors which may show variable appearance in standard magnetic resonance imaging (MRI) depending on their origin (primary or secondary) or patients' immunological status.

Objectives: The aim of the study was to analyze imaging patterns of different CNSLs, using diffusion-weighted imaging (DWI) and perfusion-weighted imaging (PWI).

Material And Methods: Our material consisted of 16 CNSLs (14 primary, 2 secondary, 13 immunocompetent, 3 immunodeficient) which underwent magnetic resonance (MR) examinations including DWI and T2* dynamic susceptibility contrast (DSC) perfusion (without a preload in 13 cases, with a preload in 3 subjects). In DWI, apparent diffusion coefficient (ADC), and in PWI, parameters of relative cerebral blood volume (rCBV), relative peak height (rPH) and relative percentage of signal recovery (rPSR) were analyzed within the entire tumor (mean values) and in regions with minimal diffusion (ADCmin) and maximal perfusion values (rCBVmax, rPHmax, rPSRmax).

Results: All CNSLs showed low values of ADCmean (0.70 × 10-3), ADCmin (0.54 × 10-3), rCBVmean (0.80), rCBVmax (1.27), rPHmean (1.05), rPHmax (1.59), as well as high values of rPSRmean (1.99) and rPSRmax (2.41). There were no significant differences in rCBVmax, as well as in all ADC, rPH and rPSR values between primary and secondary CNSLs or between tumors in immunocompetent and immunodeficient patients. Dynamic susceptibility contrast PWI with a preload resulted in significantly higher rCBV, rPH and lower rPSR values.

Conclusions: Despite various MR appearances, both primary and secondary CNSLs in immunocompetent and immunodeficient patients show very typical patterns of restricted diffusion and hypoperfusion with signal intensity curves returning above the baseline. Dynamic susceptibility contrast perfusion without a preload is recommended.
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http://dx.doi.org/10.17219/acem/73894DOI Listing
August 2018

Cerebral Metastases of Lung Cancer Mimicking Multiple Ischaemic Lesions - A Case Report and Review of Literature.

Pol J Radiol 2017 15;82:530-535. Epub 2017 Sep 15.

Department of General Radiology, Interventional Radiology and Neuroradiology, Wrocław Medical University, Wrocław, Poland.

Background: Restricted diffusion that is found on magnetic resonance diffusion-weighted imaging (DWI) typically indicates acute ischaemic stroke. However, restricted diffusion can also occur in other diseases, like metastatic brain tumours, which we describe in this case report.

Case Report: A 57-year-old male, with a diagnosis of small-cell cancer of the right lung (microcellular anaplastic carcinoma), was admitted with focal neurological symptoms. Initial brain MRI revealed multiple, disseminated lesions that were hyperintense on T2-weighted images and did not enhance after contrast administration; notably, some lesions manifested restricted diffusion on DWI images. Based on these findings, disseminated ischaemic lesions were diagnosed. On follow-up MRI that was performed after 2 weeks, we observed enlargement of the lesions; there were multiple, disseminated, sharply outlined, contrast-enhancing, oval foci with persistent restriction of diffusion. We diagnosed the lesions as disseminated brain metastases due to lung cancer. To our knowledge, this is the first description of a patient with brain metastases that were characterised by restricted diffusion and no contrast enhancement.

Conclusions: Multiple, disseminated brain lesions, that are characterised by restricted diffusion on DWI, typically indicate acute or hyperacute ischemic infarcts; however, they can also be due to hypercellular metastases, even if no contrast enhancement is observed. This latter possibility should be considered particularly in patients with cancer.
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http://dx.doi.org/10.12659/PJR.902213DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5894122PMC
September 2017