The vestibular system, essential for balance and spatial orientation, spans from the inner ear to various brain regions. Advances in imaging techniques have significantly enhanced our ability to diagnose and treat vestibular disorders. This review explores the anatomy of the vestibular system and evaluates the roles of high-resolution computed tomography (CT) and magnetic resonance imaging (MRI) in diagnosing structural abnormalities. CT is particularly useful for identifying bony labyrinth anomalies, temporal bone fractures, and superior canal dehiscence, though it has limitations in visualizing membranous labyrinth lesions. MRI, with its superior soft tissue resolution, is preferred for detecting retrocochlear lesions such as vestibular schwannomas, cerebellopontine angle tumors, and demyelinating diseases in the posterior fossa. Functional MRI also offers insights into the vestibular system’s functional aspects. The review emphasizes the increasing importance of imaging diagnostics in the effective management of vestibular system diseases, highlighting both structural and functional imaging modalities to improve patient outcomes.
The vestibular cortex is a distributed network of multisensory areas that plays a crucial role in balance, posture, and spatial orientation. The core region of the vestibular cortex is the parietoinsular vestibular cortex (PIVC), which is located at the junction between the posterior insula, parietal operculum, and retroinsular region. The PIVC is connected to other vestibular areas, the primary and secondary somatosensory cortices, and the premotor and posterior parietal cortices. It also sends projections to the vestibular nuclei in the brainstem. The PIVC is a multisensory region that integrates vestibular, visual, and somatosensory information to create a representation of head-in-space motion, which is used to control eye movements, posture, and balance. Other regions of the vestibular cortex include the primary somatosensory, posterior parietal, and frontal cortices. The primary somatosensory cortex is involved in processing information about touch and body position. The posterior parietal cortex is involved in integrating vestibular, visual, and somatosensory information to create a representation of spatial orientation. The frontal cortex is involved in controlling posture, and eye movements. The various methods used to stimulate the vestibular receptors in neuroimaging studies include caloric vestibular stimulation (CVS), galvanic vestibular stimulation (GVS), and auditory vestibular stimulation (AVS). CVS uses warm or cold water or air to stimulate the semicircular canals, GVS uses a weak electrical current to stimulate the vestibular nerve, and AVS uses high-intensity clicks or short tone bursts to stimulate the otolithic receptors.
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Background We aimed to identify any differences in the structural covariance network
based on structural volume and those in the functional network based on cerebral blood flow between the ipsilateral and contralateral hemispheres of pain in patients with episodic migraine without aura.
Methods We prospectively enrolled 27 patients with migraine without aura, all of whom had unilateral migraine pain. We defined the ipsilateral hemisphere as the side of migraine pain. We measured structural volumes on three-dimensional T1-weighted images and cerebral blood flow using arterial spin labeling magnetic resonance imaging. We then analyzed the structural covariance network based on structural volume and the functional network based on cerebral blood flow using graph theory.
Results There were no significant differences in structural volume or cerebral blood flow
between the ipsilateral and contralateral hemispheres. However, there were significant differences between the hemispheres in the structural covariance network and the functional network. In the structural covariance network, the betweenness centrality of the thalamus was lower in the ipsilateral hemisphere than in the contralateral hemisphere. In the functional network, the betweenness centrality of the anterior cingulate and paracingulate gyrus was lower in the ipsilateral hemisphere than in the contralateral hemisphere, while that of the opercular part of the inferior frontal gyrus was higher in the former hemisphere.
Conclusions The present findings indicate that there are significant differences in the structural covariance network and the functional network between the ipsilateral and contralateral hemispheres of pain in patients with episodic migraine without aura.
Tram-track and doughnut-shaped enhancements of the optic nerve sheath in axial and coronal magnetic resonance imaging (MRI) views, respectively, play crucial roles in the diagnosis of optic nerve sheath meningioma (ONSM). However, this finding is not specific to ONSM since it can also be observed in optic perineuritis (OPN). Here we report a 42-year-old female with ONSM who presented with clinical and MRI findings similar to those of OPN.
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Background Unilateral peripheral facial nerve palsy may have a detectable cause (secondary facial nerve palsy) or may be idiopathic (Bell’s palsy). Facial palsy is attributable to various causes ranging from mild infection to severe neurological disorders. We investigated the prevalence and types of serious neurological disorders in patients with unilateral facial palsy.
Methods We reviewed the medical records of patients with unilateral facial nerve palsy and identified patients diagnosed with facial palsy secondary to serious or life-threatening causes. We investigated the clinical characteristics, as well as electrodiagnostic and imaging findings in these patients.
Results Of 924 patients with facial palsy, 11 patients (1.2%) were diagnosed with the following serious neurological disorders: acoustic schwannoma in two patients, facial nerve schwannoma, glossopharyngeal schwannoma, meningioma, epidermoid cyst, parotid gland tumor, pontine infarct, skull base osteomyelitis, brain metastasis, and pachymeningitis.
Conclusions Although unilateral facial palsy is rarely associated with serious neurological disorders, early detection of the etiopathogenetic contributors is important for prompt initiation of optimal management. Therefore, clinicians should be mindful of disorders that can mimic Bell’s palsy.
The pathogenesis of many strokes originates in the vessel wall. Despite this, most traditional imaging focuses on the vascular lumen. Vessel-wall magnetic resonance imaging (VWMRI) is useful for establishing the etiology of intracranial stenosis. It also provides information regarding atherosclerotic plaque composition and thus plaque vulnerability, which is an indication of its potential to cause a stroke. In this review we focus on the characteristics of VWMRI findings in various arteriopathies related to intracranial artery stenosis, and discuss the clinical implications of these findings.
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Focal eosinophilic myositis (FEM) is the most limited form of eosinophilic myositis that commonly affects the muscles of the lower leg without systemic manifestations. We report a patient with FEM who was studied by magnetic resonance imaging and muscle biopsy with a review of the literature.
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Background Magnetic resonance (MR) images are useful for diagnosing myopathy. The purpose of this study was to determine the usefulness of lower-limb MR images in Korean patients with distal myopathy.
Methods We reviewed medical records in the myopathy database from January 2002 to October 2016. We selected 21 patients from 91 unrelated families with distal myopathy: four with GNE myopathy, 11 with dysferlinopathy, and six with ADSSL1 myopathy.
Results Ten (48%) of the 21 patients were men. The ages of the participants at symptom onset and imaging were 19.2 ± 9.5 and 30.4 ± 9.0 years (mean ± standard deviation), respectively. Their grade on the modified Gardner-Medwin and Walton grade was 3.3 ± 1.7. The strength grade of the knee extensors was not correlated with the Mercuri scale for the quadriceps (r = –0.247, p = 0.115). However, the Medical Research Council grades of the knee flexors, ankle dorsiflexors, and ankle plantar flexors were significantly correlated with the Mercuri scale ratings of the knee flexors (r = –0.497, p = 0.001), tibialis anterior (r = –0.727, p < 0.001), and ankle plantar flexors (r = –0.620, p < 0.001), respectively. T1-weighted MR images showed characteristic fatty replacement patterns that were consistent with the causative genes. Unsupervised hierarchical clustering of the Mercuri scale showed that the main factors contributing to the dichotomy were the causative gene and the clinical severity.
Conclusions This study is the first to reveal the usefulness of lower-limb MR images in the differential diagnosis of distal myopathy in Korea.
Transient global amnesia is a syndrome of temporary loss of short-term memory and is not accompanied by any other neurological deficit. Diffusion-weighted imaging is useful to improve the diagnostic accuracy of transient global amnesia. We report a 68-year-old woman with multiple lesions on diffusion-weighted imaging in the right corpus callosum and left hippocampus. To the best of our knowledge, this is the first case of a diffusion-weighted imaging lesion in the body portion of the corpus callosum.
Multifocal acquired demyelinating sensory and motor (MADSAM) neuropathy is a variant of chronic acquired demyelinating polyneuropathy. A 65-year-old women presented with upper arm weakness. A nerve conduction study showed conduction blocks over intermediate
segments with sparing of distal compound action potentials. Magnetic resonance imaging revealed asymmetric hypertrophy of the brachial plexus on the affected side. These findings
represent important electrophysiological and radiological evidence of MADSAM neuropathy. The condition of the patient began to improve after starting intravenous immunoglobulin administration.
In this article, we review the differences of the brain morphology according to age, sex, and handedness. Age is a well-known factor affecting brain morphology. With aging, progressive reduction of brain volume is driven. Sex also has great effects on brain morphology. Although there are some reports that the differences of brain morphology may originate from the differences of weight between the 2 sexes, studies have demonstrated that there are regional differences even after the correction for weight. Handedness has long been regarded as a behavioral marker of functional asymmetry. Although there have been debates about the effect of handedness on brain morphology, previous well-established studies suggest there are differences in some regions according to handedness. Even with the studies done so far, normal brain morphology is not fully understood. Therefore, studies specific for the each ethnic group and standardized methods are needed to establish a more reliable database of healthy subjects’ brain morphology.
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Amyotrophic lateral sclerosis (ALS) is a progressive motor neuron degenerative disease that clinically manifests both upper and lower motor neuron signs. However, it is unknown where and how the motor neuron degeneration begins, and conflicting hypotheses have been suggested. Recent advanced radiological techniques enable us to look into ALS neuropathology in vivo. Herein, we report a case with upper motor neuron-predominant ALS in whom the results of brain magnetic resonance imaging (MRI) and myelin water fraction MRI suggest axonal degeneration.
Seong-Ho Park, Hyunwoo Nam, Won-Joon Choi, Hee Jin Yang, Hye Won Chung, Sam Soo Kim, Sang Hyung Lee, Yong-Seok Lee, Chi Sung Song, Young Seob Chung, Kwang-Woo Lee
Purpose : Carpal tunnel syndrome(CTS) is a disorder of median nerve at wrist. it is usually diagnosed through clinical manifestation and nerve conduction study(NCS). However, sometimes, NCS does not provide a reliable evidence to reach the diagnosis. Thus, authors performed this study to determine whether NCS was correlated with specific parameters measured on magnetic resonance imaging (MRI) which might become a potential complemental diagnostic tool. Methods : We performed MRI in 34 wrists of 18 patients with clinical manifestations of CTS and pathologic nerve conduction values and analyzed them at levels of the distal radioulnar joint, pisiform and hook of hamate. Results : Increase in the cross-sectional area of the median nerve a the pisiform level and flattening, increased signal intensity, and contrast enhancement of the median nerve at levels of the pisiform and hook of hamate were statistically significant, Change in cross sectional areas between the distal radioulnar joint and hamate and the signal intensities at levels of pisiform and hamate were well correlated with the median nerve conduction velocity. Conclusions : Characteristic MRI findings in CTS reported previously were well demonstrated and some of MRI parameters are well correlated with nerve conduction study. MRI, despite cost, may help in evaluating CTS.
A 28-year-old man presented with headache, fever, and myalgia. Subsequently, rapidly progressive quadriplegia withareflexia developed. CSF examination revealed moderate pleocytosis and protein elevation. MRI of brain and spinalcord showed hyperintense lesions on T2-weighted image at midbrain and ventral horns along the whole spinal cord.Serial serologic examinations of CSF for Epstein-Barr virus and cytomegalovirus were negative. Culture and neutralizationtests of stool and CSF for enterovirus were negative. Although the etiologic pathogen was not identified, we diagnosedhim as poliomyelitis-like syndrome by clinical features and findings of MRI.
Background Tarsal tunnel syndrome (TTS) is an entrapment neuropathy that occurs in the ankle. Previous studies reportedthat this disease was due to physiologic factors and structural lesions in the ankle or foot. The authors investigated the causativefactors of TTS and their frequency via operative findings. The diagnostic value of MRI was also evaluated based onthe concordance between the operative findings and the MRI findings. Methods: This study was performed in retrospectiveby using medical record of the patients who underwent operations with TTS from August 2003 to May 2010. Physical examination,nerve conduction study, and MRI were conducted on patients who visited department of neurology or orthopedicsurgery due to pain and sensory abnormality of their ankle and foot. Results: 34 patients underwent the operation. Ganglionaccounted for the largest portion of the operative findings. In addition, varicose veins, intrinsic foot muscle hypertrophy, tenosynovitis,and fascia thickening were mainly observed. Of the 34 patients, 33 patients underwent pre-operative MRI, of whom18 patients showed MRI findings consistent with the operative findings. Conclusions: Space-occupying lesions accounted forthe majority of the causative factors in TTS patients who underwent the surgical treatment. In this study, the MRI appeareduseful for identifying causes of TTS.
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