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Jiun-jie Wang - One of the best experts on this subject based on the ideXlab platform.

  • Clinical significance of the pallidoreticular pathway in patients with Carbon Monoxide Intoxication.
    Brain : a journal of neurology, 2011
    Co-Authors: Chiung-chih Chang, Wen-neng Chang, Chun-chung Lui, Shu-hua Huang, Chen-chang Lee, Ching Chen, Jiun-jie Wang
    Abstract:

    Whereas globus pallidus lesions resulting from Carbon Monoxide Intoxication have been extensively described in the literature, the clinical significance of pallidoreticular lesions has rarely been mentioned. This study incorporated information from functional and structural imaging to explore the correlations of pallidoreticular lesions with parkinsonian features and neurobehavioural performance. Twenty-five patients (11 males) with globus pallidus lesions after Carbon Monoxide Intoxication and 25 age- and sex-matched controls were enrolled for detailed neurological examinations, cognitive testing, susceptibility weighted imaging, diffusion tensor imaging and 99mTc-TRODAT-1 single photon emission computed tomography. The post-processing analysis of the neuroimaging included voxel-based morphometry to assess the regional atrophy, tract-based spatial statistics related to white matter involvement, tractography to investigate the rostral and caudal projections from the midbrain level and specific uptake ratios of 99mTc-TRODAT-1 for presynaptic dopaminergic transporter activity. In susceptibility weighted imaging, low-intensity pallidoreticular lesions were detected from the minimal-intensity projections, which were visible in only 7.7% of the T(1)-weighted images and 15.4% of the T(2)-weighted images, whereas inhomogeneous intensities were detected in the globus pallidus. The patients were further divided into two subgroups based on the presence (n = 13) or absence (n = 12) of pallidoreticular lesions. The patients with pallidoreticular lesions showed increased parkinsonian features, poorer performances on the neuropsychiatric tests, lower 99mTc-TRODAT-1 availability in both the caudate and the putamen and greater atrophy of the thalamus, posterior corpus callosum, cerebral peduncle and white matter surrounding the globus pallidus compared to those without pallidoreticular lesions. The tractography results obtained with seed regions of interest in the substantia nigra showed rostral projections to the supplementary motor cortex and anterior cingulate cortex via the globus pallidus; the two pathways were distinct but ran in parallel, caudal to the level of the globus pallidus. In conclusion, the presence of pallidoreticular lesions after Carbon Monoxide Intoxication indicates a poorer cognitive state, which is associated with extensive grey and white matter damage in addition to the damage to the nigra-striatal neuronal networks. The presence of parkinsonian features may be related to pallidal and presynaptic dopaminergic dysfunction. The sensitivity for detecting pallidoreticular lesions can be greatly improved by using susceptibility weighted imaging compared with conventional imaging.

  • Clinical significance of the pallidoreticular pathway in patients with Carbon Monoxide Intoxication
    Brain, 2011
    Co-Authors: Chiung-chih Chang, Wen-neng Chang, Chun-chung Lui, Shu-hua Huang, Chen-chang Lee, Ching Chen, Jiun-jie Wang
    Abstract:

    Whereas globus pallidus lesions resulting from Carbon Monoxide Intoxication have been extensively described in the literature, the clinical significance of pallidoreticular lesions has rarely been mentioned. This study incorporated information from functional and structural imaging to explore the correlations of pallidoreticular lesions with parkinsonian features and neurobehavioural performance. Twenty-five patients (11 males) with globus pallidus lesions after Carbon Monoxide Intoxication and 25 age- and sex-matched controls were enrolled for detailed neurological examinations, cognitive testing, susceptibility weighted imaging, diffusion tensor imaging and 99mTc-TRODAT-1 single photon emission computed tomography. The post-processing analysis of the neuroimaging included voxel-based morphometry to assess the regional atrophy, tract-based spatial statistics related to white matter involvement, tractography to investigate the rostral and caudal projections from the midbrain level and specific uptake ratios of 99mTc-TRODAT-1 for presynaptic dopaminergic transporter activity. In susceptibility weighted imaging, low-intensity pallidoreticular lesions were detected from the minimal-intensity projections, which were visible in only 7.7% of the T1-weighted images and 15.4% of the T2-weighted images, whereas inhomogeneous intensities were detected in the globus pallidus. The patients were further divided into two subgroups based on the presence ( n  = 13) or absence ( n  = 12) of pallidoreticular lesions. The patients with pallidoreticular lesions showed increased parkinsonian features, poorer performances on the neuropsychiatric tests, lower 99mTc-TRODAT-1 availability in both the caudate and the putamen and greater atrophy of the thalamus, posterior corpus callosum, cerebral peduncle and white matter surrounding the globus pallidus compared to those without pallidoreticular lesions. The tractography results obtained with seed regions of interest in the substantia nigra showed rostral projections to the supplementary motor cortex and anterior cingulate cortex via the globus pallidus; the two pathways were distinct but ran in parallel, caudal to the level of the globus pallidus. In conclusion, the presence of pallidoreticular lesions after Carbon Monoxide Intoxication indicates a poorer cognitive state, which is associated with extensive grey and white matter damage in addition to the damage to the nigra-striatal neuronal networks. The presence of parkinsonian features may be related to pallidal and presynaptic dopaminergic dysfunction. The sensitivity for detecting pallidoreticular lesions can be greatly improved by using susceptibility weighted imaging compared with conventional imaging. * Abbreviations : SPECT : single photon emission computed tomography 99mTc-TRODAT-1 : 99mTc-\[2-[[2-[[[3-(4-chlorophenyl)-8-methyl-8-azabicyclo [3,2,1] oct-2-yl] methyl\] (2-mercaptoethyl) amino] ethyl] amino]-ethanethiolate(3-)-N2,N2′,S2,S2]oxo-[1R-(exo-exo)]

Chiung-chih Chang - One of the best experts on this subject based on the ideXlab platform.

  • Neuroimaging Studies in Carbon Monoxide Intoxication
    Neuroimaging - Cognitive and Clinical Neuroscience, 2012
    Co-Authors: Ya-ting Chang, Wen-neng Chang, Chun-chung Lui, Shu-hua Huang, Chen-chang Lee, Nai-ching Chen, Chiung-chih Chang
    Abstract:

    CO is a tasteless, odorless and colorless gas. The existence of endogenous CO in the human body arises from heme catabolism (Meredith and Vale 1988; Ernst and Zibrak 1998) and oxidation of organic molecules (Marilena 1997). Endogenous CO acts as a neurotransmitter for long-term potentiation, consequently playing a key role in memory and learning (Marilena 1997). It also plays a role in modulating inflammation, apoptosis, cell proliferation, mitochondrial biogenesis (Weaver 2009) and vascular relaxation (Marilena 1997). Exogenous sources of CO Intoxication include smoking, forest fires, pollutants, and improper usage of heaters or furnaces (Weaver 2009; Kumar, Prakash et al. 2010). CO Intoxication usually indicates exposure to exogenous sources and is considered one of the most common causes of poisoning worldwide (Prockop and Chichkova 2007; Weaver 2009), with 1000 deaths annually in Britain (Meredith and Vale 1988), and 4000-6000 deaths annually in the United States (Tibbles and Perrotta 1994; Ernst and Zibrak 1998; Weaver 1999). In Asia, the exact epidemiology remains unclear. In Japan, Hong Kong and Taiwan, a common CO etiology of Intoxication is charcoal burning suicide (Lee, Chan et al. 2002). In Japan, poisoning by charcoal burning is the most lethal form of suicide and is a highly prevalent method among men aged 25-64 years of age (Kamizato, Yoshitome et al. 2009), in contrast to a high rate of drug poisoning as a method of suicide in women. In Hong Kong, the risk factors of suicide by charcoal burning are male and living alone with financial stress (Lee and Leung 2009). In Taiwan, charcoal burning was not a common method of suicide before 1998, with a rate of only 0.14 per 105 people per year (Lin and Lu 2008). With the dissemination of media and the internet, the rate of charcoal burning suicides dramatically increased by 40-fold, reaching a rate of 5.38 per 105 people per year in 2005 (Lin and Lu 2008).

  • Pallidoreticular lesion in Carbon Monoxide Intoxication by gradient echo: report of a case with parkinsonism features and review of the literature.
    Acta neurologica Taiwanica, 2012
    Co-Authors: Nai-ching Chen, Wen-neng Chang, Chun-chung Lui, Shu-hua Huang, Chen-chang Lee, Chi-wei Huang, Chang-hung Chen, Yu-ting Lin, Chiung-chih Chang
    Abstract:

    Purpose: Pallidoreticular damage was defined by lesions involving both the pallidum and the substantia nigra and was only reported in four cases after CO Intoxication. Case Report: We report a patient with initial consciousness disturbances followed by parkinsonian features after Carbon Monoxide Intoxication. The unique features in this patient included primary globus pal- lidus hemorrhage followed by delayed hemorrhage in pallidoreticular topography demonstrated by T1- and T2-weighted imaging. In the follow-up study 7 months later, the patient still presented with parkin- sonism features and executive dysfunction while the pallidoreticular signal was only visible by gradient echo sequences but not the other MR conventional sequences. Hypometabolism in the frontal and basal ganglion regions were evident from 99mTc-TRODAT-1 study and partial responsiveness to levodopa in alleviating parkinsonian features was considered. Conclusion: This case highlights the delayed development of pallidoreticular damages and its linkage in modulating prefrontal-subcortical neuronal circuits.

  • Clinical significance of the pallidoreticular pathway in patients with Carbon Monoxide Intoxication.
    Brain : a journal of neurology, 2011
    Co-Authors: Chiung-chih Chang, Wen-neng Chang, Chun-chung Lui, Shu-hua Huang, Chen-chang Lee, Ching Chen, Jiun-jie Wang
    Abstract:

    Whereas globus pallidus lesions resulting from Carbon Monoxide Intoxication have been extensively described in the literature, the clinical significance of pallidoreticular lesions has rarely been mentioned. This study incorporated information from functional and structural imaging to explore the correlations of pallidoreticular lesions with parkinsonian features and neurobehavioural performance. Twenty-five patients (11 males) with globus pallidus lesions after Carbon Monoxide Intoxication and 25 age- and sex-matched controls were enrolled for detailed neurological examinations, cognitive testing, susceptibility weighted imaging, diffusion tensor imaging and 99mTc-TRODAT-1 single photon emission computed tomography. The post-processing analysis of the neuroimaging included voxel-based morphometry to assess the regional atrophy, tract-based spatial statistics related to white matter involvement, tractography to investigate the rostral and caudal projections from the midbrain level and specific uptake ratios of 99mTc-TRODAT-1 for presynaptic dopaminergic transporter activity. In susceptibility weighted imaging, low-intensity pallidoreticular lesions were detected from the minimal-intensity projections, which were visible in only 7.7% of the T(1)-weighted images and 15.4% of the T(2)-weighted images, whereas inhomogeneous intensities were detected in the globus pallidus. The patients were further divided into two subgroups based on the presence (n = 13) or absence (n = 12) of pallidoreticular lesions. The patients with pallidoreticular lesions showed increased parkinsonian features, poorer performances on the neuropsychiatric tests, lower 99mTc-TRODAT-1 availability in both the caudate and the putamen and greater atrophy of the thalamus, posterior corpus callosum, cerebral peduncle and white matter surrounding the globus pallidus compared to those without pallidoreticular lesions. The tractography results obtained with seed regions of interest in the substantia nigra showed rostral projections to the supplementary motor cortex and anterior cingulate cortex via the globus pallidus; the two pathways were distinct but ran in parallel, caudal to the level of the globus pallidus. In conclusion, the presence of pallidoreticular lesions after Carbon Monoxide Intoxication indicates a poorer cognitive state, which is associated with extensive grey and white matter damage in addition to the damage to the nigra-striatal neuronal networks. The presence of parkinsonian features may be related to pallidal and presynaptic dopaminergic dysfunction. The sensitivity for detecting pallidoreticular lesions can be greatly improved by using susceptibility weighted imaging compared with conventional imaging.

  • Clinical significance of the pallidoreticular pathway in patients with Carbon Monoxide Intoxication
    Brain, 2011
    Co-Authors: Chiung-chih Chang, Wen-neng Chang, Chun-chung Lui, Shu-hua Huang, Chen-chang Lee, Ching Chen, Jiun-jie Wang
    Abstract:

    Whereas globus pallidus lesions resulting from Carbon Monoxide Intoxication have been extensively described in the literature, the clinical significance of pallidoreticular lesions has rarely been mentioned. This study incorporated information from functional and structural imaging to explore the correlations of pallidoreticular lesions with parkinsonian features and neurobehavioural performance. Twenty-five patients (11 males) with globus pallidus lesions after Carbon Monoxide Intoxication and 25 age- and sex-matched controls were enrolled for detailed neurological examinations, cognitive testing, susceptibility weighted imaging, diffusion tensor imaging and 99mTc-TRODAT-1 single photon emission computed tomography. The post-processing analysis of the neuroimaging included voxel-based morphometry to assess the regional atrophy, tract-based spatial statistics related to white matter involvement, tractography to investigate the rostral and caudal projections from the midbrain level and specific uptake ratios of 99mTc-TRODAT-1 for presynaptic dopaminergic transporter activity. In susceptibility weighted imaging, low-intensity pallidoreticular lesions were detected from the minimal-intensity projections, which were visible in only 7.7% of the T1-weighted images and 15.4% of the T2-weighted images, whereas inhomogeneous intensities were detected in the globus pallidus. The patients were further divided into two subgroups based on the presence ( n  = 13) or absence ( n  = 12) of pallidoreticular lesions. The patients with pallidoreticular lesions showed increased parkinsonian features, poorer performances on the neuropsychiatric tests, lower 99mTc-TRODAT-1 availability in both the caudate and the putamen and greater atrophy of the thalamus, posterior corpus callosum, cerebral peduncle and white matter surrounding the globus pallidus compared to those without pallidoreticular lesions. The tractography results obtained with seed regions of interest in the substantia nigra showed rostral projections to the supplementary motor cortex and anterior cingulate cortex via the globus pallidus; the two pathways were distinct but ran in parallel, caudal to the level of the globus pallidus. In conclusion, the presence of pallidoreticular lesions after Carbon Monoxide Intoxication indicates a poorer cognitive state, which is associated with extensive grey and white matter damage in addition to the damage to the nigra-striatal neuronal networks. The presence of parkinsonian features may be related to pallidal and presynaptic dopaminergic dysfunction. The sensitivity for detecting pallidoreticular lesions can be greatly improved by using susceptibility weighted imaging compared with conventional imaging. * Abbreviations : SPECT : single photon emission computed tomography 99mTc-TRODAT-1 : 99mTc-\[2-[[2-[[[3-(4-chlorophenyl)-8-methyl-8-azabicyclo [3,2,1] oct-2-yl] methyl\] (2-mercaptoethyl) amino] ethyl] amino]-ethanethiolate(3-)-N2,N2′,S2,S2]oxo-[1R-(exo-exo)]

Hrvoje Budinčević - One of the best experts on this subject based on the ideXlab platform.

  • Parkinsonism due to Fahr’s disease with previous Carbon Monoxide Intoxication
    Acta neurologica Belgica, 2015
    Co-Authors: Anita Marčinko Budinčević, Tomislav Pavlović, Anamarija Soldo Koruga, Hrvoje Budinčević
    Abstract:

    We report a 72 year male patient who presented with a progressive gait disturbance, starting hesitation and difficulties with turning around himself, which appeared in the last few years. In his neurological examination, we found short step gait in anteflexion with starting hesitation, mild masked face, micrography and mild upward gaze palsy. At the age of 34, the patient was hospitalized because of a comatose state due to Carbon Monoxide (CO) Intoxication, and the initial critical care management included cardiopulmonary resuscitation. Since then he complained of difficulties with movement synchronization. He has been treated with lacidipine, atenolol and metformin because of arterial hypertension and diabetes mellitus. Brain computed tomography (CT) and magnetic resonance (MRI) showed necrotic lesions in both caudate nuclei with calcifications in both basal ganglia (Figs. 1, 2). Wilson’s disease, hypoparathyroidism, pseudohypoparathyroidism and hyperparathyroidism were excluded. His laboratory work-up showed elevated values of glucose (9.1 mmol/L), triglycerides (2.06 mmol/L), total cholesterol (5.04 mmol/L) and LDL cholesterol (3.5 mmol/L). Symptomatic treatments with L-dopa and dopamine agonist were not successful. Our case demonstrates the markedly delayed onset of progression of parkinsonism in the patient with previous Carbon Monoxide poisoning that did not respond to conventional therapy. Most likely, the patient has Fahr’s disease according to radiological and clinical findings. However, diagnostic criteria of Fahr’s disease are not completely fulfilled, because there is a previous history of toxic exposure and no positive family history [1]. Progressive supranuclear palsy-like phenotype is associated with striopallidodentate calcification [2]. Carbon Monoxide Intoxication is one of the most common fatal accidental poisoning [3]. Parkinsonism is present in 10 % of patients with previous Carbon Monoxide poisoning, and it is usually associated with a delayed CO encephalopathy [4]. The neuroradiological findings are variable but lesions of globus pallidus and white matter lesions are common findings on brain MRI in these patients [5]. Calcifications of basal ganglia have been reported after CO Intoxication, but in most cases these calcifications are present in globus palidus and they are not extensive [6, 7]. In our case, extensive lesions in caudate nuclei are probably caused by Fahr’s disease, but small calcifications in globus pallidus are possibly caused by previous CO Intoxication. However, the substantia nigra injury has the role in pathophysiology of CO-induced parkinsonism [8]. In conclusion, because of the impressive radiographic findings, the long interval between the CO-Intoxication and the progression of drug-resistant parkinsonism, Fahr’s disease was identified as a primary cause. The clinical picture was further influenced by probable substantia nigra injury as a consequence of previous Carbon Monoxide Intoxication. & Hrvoje Budincevic hbudincevic@gmail.com

  • Parkinsonism due to Fahr's disease with previous Carbon Monoxide Intoxication.
    Acta neurologica Belgica, 2015
    Co-Authors: Anita Marčinko Budinčević, Tomislav Pavlović, Anamarija Soldo Koruga, Hrvoje Budinčević
    Abstract:

    We report a 72 year male patient who presented with a progressive gait disturbance, starting hesitation and difficulties with turning around himself, which appeared in the last few years. In his neurological examination, we found short step gait in anteflexion with starting hesitation, mild masked face, micrography and mild upward gaze palsy. At the age of 34, the patient was hospitalized because of a comatose state due to Carbon Monoxide (CO) Intoxication, and the initial critical care management included cardiopulmonary resuscitation. Since then he complained of difficulties with movement synchronization. He has been treated with lacidipine, atenolol and metformin because of arterial hypertension and diabetes mellitus. Brain computed tomography (CT) and magnetic resonance (MRI) showed necrotic lesions in both caudate nuclei with calcifications in both basal ganglia (Figs. 1, 2). Wilson’s disease, hypoparathyroidism, pseudohypoparathyroidism and hyperparathyroidism were excluded. His laboratory work-up showed elevated values of glucose (9.1 mmol/L), triglycerides (2.06 mmol/L), total cholesterol (5.04 mmol/L) and LDL cholesterol (3.5 mmol/L). Symptomatic treatments with L-dopa and dopamine agonist were not successful. Our case demonstrates the markedly delayed onset of progression of parkinsonism in the patient with previous Carbon Monoxide poisoning that did not respond to conventional therapy. Most likely, the patient has Fahr’s disease according to radiological and clinical findings. However, diagnostic criteria of Fahr’s disease are not completely fulfilled, because there is a previous history of toxic exposure and no positive family history [1]. Progressive supranuclear palsy-like phenotype is associated with striopallidodentate calcification [2]. Carbon Monoxide Intoxication is one of the most common fatal accidental poisoning [3]. Parkinsonism is present in 10 % of patients with previous Carbon Monoxide poisoning, and it is usually associated with a delayed CO encephalopathy [4]. The neuroradiological findings are variable but lesions of globus pallidus and white matter lesions are common findings on brain MRI in these patients [5]. Calcifications of basal ganglia have been reported after CO Intoxication, but in most cases these calcifications are present in globus palidus and they are not extensive [6, 7]. In our case, extensive lesions in caudate nuclei are probably caused by Fahr’s disease, but small calcifications in globus pallidus are possibly caused by previous CO Intoxication. However, the substantia nigra injury has the role in pathophysiology of CO-induced parkinsonism [8]. In conclusion, because of the impressive radiographic findings, the long interval between the CO-Intoxication and the progression of drug-resistant parkinsonism, Fahr’s disease was identified as a primary cause. The clinical picture was further influenced by probable substantia nigra injury as a consequence of previous Carbon Monoxide Intoxication. & Hrvoje Budincevic hbudincevic@gmail.com

  • CASE REPORT: PARKINSONISM DUE TO Carbon Monoxide Intoxication
    2013
    Co-Authors: Anita Marčinko Budinčević, Mijo Babić, Hrvoje Budinčević
    Abstract:

    Parkinsonism after Carbon Monoxide Intoxication occurs in 10% of patients. Lesions of globus pallidus and white matter lesions are common findings on brain MRI in these patients. Aim oft he study was to present a patient with parkinsonsim due to Carbon Monoxide Intoxication. We describe a 72-year male patient who presented to our out-patient clinic with worsening of symptoms that have been present for the past five years consisting of progresive gait disturbance with starting hesitation and difficulties with fast turning around himself. In his neurological examination we found short step gait in anteflexion with starting hesitation, mild masked face, micrography and mild upward gaze palsy. He has been treated beacuse of arterial hypertension and diabetes mellitus. In the age of 34, the patient was hospitalized because of a comatose state due to Carbon Monoxide Intoxication, and the initial critical care management included cardiopulmonary resuscitation. Since then he complains of difficulties with movement synchronization. Brani MRI and CT showed malatic lesions with calcifications in both basal ganglia and the signs of cerebro-vascular disease. A symptomatic treatment has been started with L-dopa and later on dopamine agonist and has not been succesful. Patients with Carbon Monoxide Intoxication that had undergone cardio-pulmonary resuscitation might develop parkinsonism due to bilateral lesions of basal ganglia, which can be confirmed with neuroradiological examination.

Chen-chang Lee - One of the best experts on this subject based on the ideXlab platform.

  • Neuroimaging Studies in Carbon Monoxide Intoxication
    Neuroimaging - Cognitive and Clinical Neuroscience, 2012
    Co-Authors: Ya-ting Chang, Wen-neng Chang, Chun-chung Lui, Shu-hua Huang, Chen-chang Lee, Nai-ching Chen, Chiung-chih Chang
    Abstract:

    CO is a tasteless, odorless and colorless gas. The existence of endogenous CO in the human body arises from heme catabolism (Meredith and Vale 1988; Ernst and Zibrak 1998) and oxidation of organic molecules (Marilena 1997). Endogenous CO acts as a neurotransmitter for long-term potentiation, consequently playing a key role in memory and learning (Marilena 1997). It also plays a role in modulating inflammation, apoptosis, cell proliferation, mitochondrial biogenesis (Weaver 2009) and vascular relaxation (Marilena 1997). Exogenous sources of CO Intoxication include smoking, forest fires, pollutants, and improper usage of heaters or furnaces (Weaver 2009; Kumar, Prakash et al. 2010). CO Intoxication usually indicates exposure to exogenous sources and is considered one of the most common causes of poisoning worldwide (Prockop and Chichkova 2007; Weaver 2009), with 1000 deaths annually in Britain (Meredith and Vale 1988), and 4000-6000 deaths annually in the United States (Tibbles and Perrotta 1994; Ernst and Zibrak 1998; Weaver 1999). In Asia, the exact epidemiology remains unclear. In Japan, Hong Kong and Taiwan, a common CO etiology of Intoxication is charcoal burning suicide (Lee, Chan et al. 2002). In Japan, poisoning by charcoal burning is the most lethal form of suicide and is a highly prevalent method among men aged 25-64 years of age (Kamizato, Yoshitome et al. 2009), in contrast to a high rate of drug poisoning as a method of suicide in women. In Hong Kong, the risk factors of suicide by charcoal burning are male and living alone with financial stress (Lee and Leung 2009). In Taiwan, charcoal burning was not a common method of suicide before 1998, with a rate of only 0.14 per 105 people per year (Lin and Lu 2008). With the dissemination of media and the internet, the rate of charcoal burning suicides dramatically increased by 40-fold, reaching a rate of 5.38 per 105 people per year in 2005 (Lin and Lu 2008).

  • Pallidoreticular lesion in Carbon Monoxide Intoxication by gradient echo: report of a case with parkinsonism features and review of the literature.
    Acta neurologica Taiwanica, 2012
    Co-Authors: Nai-ching Chen, Wen-neng Chang, Chun-chung Lui, Shu-hua Huang, Chen-chang Lee, Chi-wei Huang, Chang-hung Chen, Yu-ting Lin, Chiung-chih Chang
    Abstract:

    Purpose: Pallidoreticular damage was defined by lesions involving both the pallidum and the substantia nigra and was only reported in four cases after CO Intoxication. Case Report: We report a patient with initial consciousness disturbances followed by parkinsonian features after Carbon Monoxide Intoxication. The unique features in this patient included primary globus pal- lidus hemorrhage followed by delayed hemorrhage in pallidoreticular topography demonstrated by T1- and T2-weighted imaging. In the follow-up study 7 months later, the patient still presented with parkin- sonism features and executive dysfunction while the pallidoreticular signal was only visible by gradient echo sequences but not the other MR conventional sequences. Hypometabolism in the frontal and basal ganglion regions were evident from 99mTc-TRODAT-1 study and partial responsiveness to levodopa in alleviating parkinsonian features was considered. Conclusion: This case highlights the delayed development of pallidoreticular damages and its linkage in modulating prefrontal-subcortical neuronal circuits.

  • Clinical significance of the pallidoreticular pathway in patients with Carbon Monoxide Intoxication.
    Brain : a journal of neurology, 2011
    Co-Authors: Chiung-chih Chang, Wen-neng Chang, Chun-chung Lui, Shu-hua Huang, Chen-chang Lee, Ching Chen, Jiun-jie Wang
    Abstract:

    Whereas globus pallidus lesions resulting from Carbon Monoxide Intoxication have been extensively described in the literature, the clinical significance of pallidoreticular lesions has rarely been mentioned. This study incorporated information from functional and structural imaging to explore the correlations of pallidoreticular lesions with parkinsonian features and neurobehavioural performance. Twenty-five patients (11 males) with globus pallidus lesions after Carbon Monoxide Intoxication and 25 age- and sex-matched controls were enrolled for detailed neurological examinations, cognitive testing, susceptibility weighted imaging, diffusion tensor imaging and 99mTc-TRODAT-1 single photon emission computed tomography. The post-processing analysis of the neuroimaging included voxel-based morphometry to assess the regional atrophy, tract-based spatial statistics related to white matter involvement, tractography to investigate the rostral and caudal projections from the midbrain level and specific uptake ratios of 99mTc-TRODAT-1 for presynaptic dopaminergic transporter activity. In susceptibility weighted imaging, low-intensity pallidoreticular lesions were detected from the minimal-intensity projections, which were visible in only 7.7% of the T(1)-weighted images and 15.4% of the T(2)-weighted images, whereas inhomogeneous intensities were detected in the globus pallidus. The patients were further divided into two subgroups based on the presence (n = 13) or absence (n = 12) of pallidoreticular lesions. The patients with pallidoreticular lesions showed increased parkinsonian features, poorer performances on the neuropsychiatric tests, lower 99mTc-TRODAT-1 availability in both the caudate and the putamen and greater atrophy of the thalamus, posterior corpus callosum, cerebral peduncle and white matter surrounding the globus pallidus compared to those without pallidoreticular lesions. The tractography results obtained with seed regions of interest in the substantia nigra showed rostral projections to the supplementary motor cortex and anterior cingulate cortex via the globus pallidus; the two pathways were distinct but ran in parallel, caudal to the level of the globus pallidus. In conclusion, the presence of pallidoreticular lesions after Carbon Monoxide Intoxication indicates a poorer cognitive state, which is associated with extensive grey and white matter damage in addition to the damage to the nigra-striatal neuronal networks. The presence of parkinsonian features may be related to pallidal and presynaptic dopaminergic dysfunction. The sensitivity for detecting pallidoreticular lesions can be greatly improved by using susceptibility weighted imaging compared with conventional imaging.

  • Clinical significance of the pallidoreticular pathway in patients with Carbon Monoxide Intoxication
    Brain, 2011
    Co-Authors: Chiung-chih Chang, Wen-neng Chang, Chun-chung Lui, Shu-hua Huang, Chen-chang Lee, Ching Chen, Jiun-jie Wang
    Abstract:

    Whereas globus pallidus lesions resulting from Carbon Monoxide Intoxication have been extensively described in the literature, the clinical significance of pallidoreticular lesions has rarely been mentioned. This study incorporated information from functional and structural imaging to explore the correlations of pallidoreticular lesions with parkinsonian features and neurobehavioural performance. Twenty-five patients (11 males) with globus pallidus lesions after Carbon Monoxide Intoxication and 25 age- and sex-matched controls were enrolled for detailed neurological examinations, cognitive testing, susceptibility weighted imaging, diffusion tensor imaging and 99mTc-TRODAT-1 single photon emission computed tomography. The post-processing analysis of the neuroimaging included voxel-based morphometry to assess the regional atrophy, tract-based spatial statistics related to white matter involvement, tractography to investigate the rostral and caudal projections from the midbrain level and specific uptake ratios of 99mTc-TRODAT-1 for presynaptic dopaminergic transporter activity. In susceptibility weighted imaging, low-intensity pallidoreticular lesions were detected from the minimal-intensity projections, which were visible in only 7.7% of the T1-weighted images and 15.4% of the T2-weighted images, whereas inhomogeneous intensities were detected in the globus pallidus. The patients were further divided into two subgroups based on the presence ( n  = 13) or absence ( n  = 12) of pallidoreticular lesions. The patients with pallidoreticular lesions showed increased parkinsonian features, poorer performances on the neuropsychiatric tests, lower 99mTc-TRODAT-1 availability in both the caudate and the putamen and greater atrophy of the thalamus, posterior corpus callosum, cerebral peduncle and white matter surrounding the globus pallidus compared to those without pallidoreticular lesions. The tractography results obtained with seed regions of interest in the substantia nigra showed rostral projections to the supplementary motor cortex and anterior cingulate cortex via the globus pallidus; the two pathways were distinct but ran in parallel, caudal to the level of the globus pallidus. In conclusion, the presence of pallidoreticular lesions after Carbon Monoxide Intoxication indicates a poorer cognitive state, which is associated with extensive grey and white matter damage in addition to the damage to the nigra-striatal neuronal networks. The presence of parkinsonian features may be related to pallidal and presynaptic dopaminergic dysfunction. The sensitivity for detecting pallidoreticular lesions can be greatly improved by using susceptibility weighted imaging compared with conventional imaging. * Abbreviations : SPECT : single photon emission computed tomography 99mTc-TRODAT-1 : 99mTc-\[2-[[2-[[[3-(4-chlorophenyl)-8-methyl-8-azabicyclo [3,2,1] oct-2-yl] methyl\] (2-mercaptoethyl) amino] ethyl] amino]-ethanethiolate(3-)-N2,N2′,S2,S2]oxo-[1R-(exo-exo)]

Shu-hua Huang - One of the best experts on this subject based on the ideXlab platform.

  • Neuroimaging Studies in Carbon Monoxide Intoxication
    Neuroimaging - Cognitive and Clinical Neuroscience, 2012
    Co-Authors: Ya-ting Chang, Wen-neng Chang, Chun-chung Lui, Shu-hua Huang, Chen-chang Lee, Nai-ching Chen, Chiung-chih Chang
    Abstract:

    CO is a tasteless, odorless and colorless gas. The existence of endogenous CO in the human body arises from heme catabolism (Meredith and Vale 1988; Ernst and Zibrak 1998) and oxidation of organic molecules (Marilena 1997). Endogenous CO acts as a neurotransmitter for long-term potentiation, consequently playing a key role in memory and learning (Marilena 1997). It also plays a role in modulating inflammation, apoptosis, cell proliferation, mitochondrial biogenesis (Weaver 2009) and vascular relaxation (Marilena 1997). Exogenous sources of CO Intoxication include smoking, forest fires, pollutants, and improper usage of heaters or furnaces (Weaver 2009; Kumar, Prakash et al. 2010). CO Intoxication usually indicates exposure to exogenous sources and is considered one of the most common causes of poisoning worldwide (Prockop and Chichkova 2007; Weaver 2009), with 1000 deaths annually in Britain (Meredith and Vale 1988), and 4000-6000 deaths annually in the United States (Tibbles and Perrotta 1994; Ernst and Zibrak 1998; Weaver 1999). In Asia, the exact epidemiology remains unclear. In Japan, Hong Kong and Taiwan, a common CO etiology of Intoxication is charcoal burning suicide (Lee, Chan et al. 2002). In Japan, poisoning by charcoal burning is the most lethal form of suicide and is a highly prevalent method among men aged 25-64 years of age (Kamizato, Yoshitome et al. 2009), in contrast to a high rate of drug poisoning as a method of suicide in women. In Hong Kong, the risk factors of suicide by charcoal burning are male and living alone with financial stress (Lee and Leung 2009). In Taiwan, charcoal burning was not a common method of suicide before 1998, with a rate of only 0.14 per 105 people per year (Lin and Lu 2008). With the dissemination of media and the internet, the rate of charcoal burning suicides dramatically increased by 40-fold, reaching a rate of 5.38 per 105 people per year in 2005 (Lin and Lu 2008).

  • Pallidoreticular lesion in Carbon Monoxide Intoxication by gradient echo: report of a case with parkinsonism features and review of the literature.
    Acta neurologica Taiwanica, 2012
    Co-Authors: Nai-ching Chen, Wen-neng Chang, Chun-chung Lui, Shu-hua Huang, Chen-chang Lee, Chi-wei Huang, Chang-hung Chen, Yu-ting Lin, Chiung-chih Chang
    Abstract:

    Purpose: Pallidoreticular damage was defined by lesions involving both the pallidum and the substantia nigra and was only reported in four cases after CO Intoxication. Case Report: We report a patient with initial consciousness disturbances followed by parkinsonian features after Carbon Monoxide Intoxication. The unique features in this patient included primary globus pal- lidus hemorrhage followed by delayed hemorrhage in pallidoreticular topography demonstrated by T1- and T2-weighted imaging. In the follow-up study 7 months later, the patient still presented with parkin- sonism features and executive dysfunction while the pallidoreticular signal was only visible by gradient echo sequences but not the other MR conventional sequences. Hypometabolism in the frontal and basal ganglion regions were evident from 99mTc-TRODAT-1 study and partial responsiveness to levodopa in alleviating parkinsonian features was considered. Conclusion: This case highlights the delayed development of pallidoreticular damages and its linkage in modulating prefrontal-subcortical neuronal circuits.

  • Clinical significance of the pallidoreticular pathway in patients with Carbon Monoxide Intoxication.
    Brain : a journal of neurology, 2011
    Co-Authors: Chiung-chih Chang, Wen-neng Chang, Chun-chung Lui, Shu-hua Huang, Chen-chang Lee, Ching Chen, Jiun-jie Wang
    Abstract:

    Whereas globus pallidus lesions resulting from Carbon Monoxide Intoxication have been extensively described in the literature, the clinical significance of pallidoreticular lesions has rarely been mentioned. This study incorporated information from functional and structural imaging to explore the correlations of pallidoreticular lesions with parkinsonian features and neurobehavioural performance. Twenty-five patients (11 males) with globus pallidus lesions after Carbon Monoxide Intoxication and 25 age- and sex-matched controls were enrolled for detailed neurological examinations, cognitive testing, susceptibility weighted imaging, diffusion tensor imaging and 99mTc-TRODAT-1 single photon emission computed tomography. The post-processing analysis of the neuroimaging included voxel-based morphometry to assess the regional atrophy, tract-based spatial statistics related to white matter involvement, tractography to investigate the rostral and caudal projections from the midbrain level and specific uptake ratios of 99mTc-TRODAT-1 for presynaptic dopaminergic transporter activity. In susceptibility weighted imaging, low-intensity pallidoreticular lesions were detected from the minimal-intensity projections, which were visible in only 7.7% of the T(1)-weighted images and 15.4% of the T(2)-weighted images, whereas inhomogeneous intensities were detected in the globus pallidus. The patients were further divided into two subgroups based on the presence (n = 13) or absence (n = 12) of pallidoreticular lesions. The patients with pallidoreticular lesions showed increased parkinsonian features, poorer performances on the neuropsychiatric tests, lower 99mTc-TRODAT-1 availability in both the caudate and the putamen and greater atrophy of the thalamus, posterior corpus callosum, cerebral peduncle and white matter surrounding the globus pallidus compared to those without pallidoreticular lesions. The tractography results obtained with seed regions of interest in the substantia nigra showed rostral projections to the supplementary motor cortex and anterior cingulate cortex via the globus pallidus; the two pathways were distinct but ran in parallel, caudal to the level of the globus pallidus. In conclusion, the presence of pallidoreticular lesions after Carbon Monoxide Intoxication indicates a poorer cognitive state, which is associated with extensive grey and white matter damage in addition to the damage to the nigra-striatal neuronal networks. The presence of parkinsonian features may be related to pallidal and presynaptic dopaminergic dysfunction. The sensitivity for detecting pallidoreticular lesions can be greatly improved by using susceptibility weighted imaging compared with conventional imaging.

  • Clinical significance of the pallidoreticular pathway in patients with Carbon Monoxide Intoxication
    Brain, 2011
    Co-Authors: Chiung-chih Chang, Wen-neng Chang, Chun-chung Lui, Shu-hua Huang, Chen-chang Lee, Ching Chen, Jiun-jie Wang
    Abstract:

    Whereas globus pallidus lesions resulting from Carbon Monoxide Intoxication have been extensively described in the literature, the clinical significance of pallidoreticular lesions has rarely been mentioned. This study incorporated information from functional and structural imaging to explore the correlations of pallidoreticular lesions with parkinsonian features and neurobehavioural performance. Twenty-five patients (11 males) with globus pallidus lesions after Carbon Monoxide Intoxication and 25 age- and sex-matched controls were enrolled for detailed neurological examinations, cognitive testing, susceptibility weighted imaging, diffusion tensor imaging and 99mTc-TRODAT-1 single photon emission computed tomography. The post-processing analysis of the neuroimaging included voxel-based morphometry to assess the regional atrophy, tract-based spatial statistics related to white matter involvement, tractography to investigate the rostral and caudal projections from the midbrain level and specific uptake ratios of 99mTc-TRODAT-1 for presynaptic dopaminergic transporter activity. In susceptibility weighted imaging, low-intensity pallidoreticular lesions were detected from the minimal-intensity projections, which were visible in only 7.7% of the T1-weighted images and 15.4% of the T2-weighted images, whereas inhomogeneous intensities were detected in the globus pallidus. The patients were further divided into two subgroups based on the presence ( n  = 13) or absence ( n  = 12) of pallidoreticular lesions. The patients with pallidoreticular lesions showed increased parkinsonian features, poorer performances on the neuropsychiatric tests, lower 99mTc-TRODAT-1 availability in both the caudate and the putamen and greater atrophy of the thalamus, posterior corpus callosum, cerebral peduncle and white matter surrounding the globus pallidus compared to those without pallidoreticular lesions. The tractography results obtained with seed regions of interest in the substantia nigra showed rostral projections to the supplementary motor cortex and anterior cingulate cortex via the globus pallidus; the two pathways were distinct but ran in parallel, caudal to the level of the globus pallidus. In conclusion, the presence of pallidoreticular lesions after Carbon Monoxide Intoxication indicates a poorer cognitive state, which is associated with extensive grey and white matter damage in addition to the damage to the nigra-striatal neuronal networks. The presence of parkinsonian features may be related to pallidal and presynaptic dopaminergic dysfunction. The sensitivity for detecting pallidoreticular lesions can be greatly improved by using susceptibility weighted imaging compared with conventional imaging. * Abbreviations : SPECT : single photon emission computed tomography 99mTc-TRODAT-1 : 99mTc-\[2-[[2-[[[3-(4-chlorophenyl)-8-methyl-8-azabicyclo [3,2,1] oct-2-yl] methyl\] (2-mercaptoethyl) amino] ethyl] amino]-ethanethiolate(3-)-N2,N2′,S2,S2]oxo-[1R-(exo-exo)]