Faculty Bibliography

A patient with central pontine myelinolysis (CPM) underwent neurological and mental status examination, as well as neuropsychological testing, during the acute stage of the disease. After correction of the hyponatremia, a gross change in his neuropsychiatric status was observed. The patient underwent extensive neurological, psychiatric, and neuropsychological testing during the acute phase of the disease and at follow-up 4 months later. All major neurological and neuropsychiatric symptoms present at onset were fully reversible. Neuropsychological examination revealed deficits in the domains of attention and concentration, short-term memory and memory consolidation, visual motor and fine motor speeds, and learning ability. Although improved, neuropsychological testing still revealed remarkable deficits at follow-up. We conclude that neuropsychological deficits can accompany CPM, and that these deficits do not necessarily diminish simultaneously with the radiological or clinical neurological findings but may persist for a longer period of time, or even become permanent. In his recovery the patient started to manifest new neurological symptoms consisting of a mild resting tremor of both hands and slow choreoathetotic movements of the trunk and the head, which we considered to be late neurological sequelae of CPM. The significance of CPM in the differential diagnosis of acute behavioral changes after correction of hyponatremia is stressed, even if correction is achieved slowly and carefully.

Although positron emission tomography (PET) provides important physiological information, a major limitation of this technique is poor anatomical resolution. Combining the superior anatomical resolution of magnetic resonance imaging (MRI) with the physiologic information of PET could be an important advance for clinical and research applications of PET. The purpose of this study was to develop reliable methods for using MRI in the definition of brain regions of interest (ROIs) for application to coregistered PET brain images. First, specific criteria were developed for definition of ROIs on coregistered MRI using anatomical landmarks from a standard anatomical atlas. ROIs were then drawn by three independent raters using the criteria on 11 MRI scans, which had been coregistered to PET [(18)F]2-fluoro-2-deoxyglucose (FDG) brain scans. These MRI-based templates were used to determine activity in various brain regions on the PET scans, which were used in the determination of regional brain metabolic rates. There was a high level of agreement between raters for the measurement of regional metabolic rates, with intra-class correlation coefficients ranging from 0.63-0.98. These findings suggest that specific ROI criteria based on coregistered MRI are a reliable method of measuring activity from PET images. The use of a standard and widely available atlas and readily applicable criteria for ROIs should facilitate a standard method of measurement which can be applied in a similar manner at different PET sites.

We have previously reported smaller hippocampal volume and deficits in short-term memory in patients with combat-related posttraumatic stress disorder (PTSD) relative to comparison subjects. The purpose of this study was to compare hippocampal volume in adult survivors of childhood abuse to matched controls. Magnetic resonance imaging was used to measure volume of the hippocampus in adult survivors of childhood abuse (n = 17) and healthy subjects (n = 17) matched on a case-by-case basis for age, sex, race, handedness, years of education, body size, and years of alcohol abuse. All patients met criteria for PTSD secondary to childhood abuse. PTSD patients had a 12% smaller left hippocampal volume relative to the matched controls (p < .05), without smaller volumes of comparison regions (amygdala, caudate, and temporal lobe). The findings were significant after controlling for alcohol, age, and education, with multiple linear regression. These findings suggest that a decrease in left hippocampal volume is associated with abuse-related PTSD.

Prize Winnning Paper