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Cavernous Angiomas: Screening Of A Family Over Three Generations

Cavernous angiomas belong to a group of intracranial vascular malformations that are developmental malformations of the vascular bed. These congenital abnormal vascular connections frequently enlarge over time. The lesions can occur on a familial basis. Patients may be asymptomatic, although they often present with headaches, seizures, or small parenchymal hemorrhages.

In most patients, cavernous angiomas are solitary and asymptomatic. In recent times, increasing MRI has detected several such asymptomatic cases and has prompted a study into the genetics and natural history of this condition.

It is now known that cavernous angiomas have a genetic basis. Familial forms of cavernous angiomas are associated with a set of genes called CCM genes (cerebral cavernous angioma). This is a case report describing the phenotypic expression of a familial form of cavernous angioma.

CASE REPORT

A 54-year-old man was referred for an MRI of the brain with complaints of headache and seizures. A cranial CT scan revealed few hyperdense lesions. A subsequent cranial MRI scan revealed several lesions with features representing cavernous angiomas.

The patient was offered counseling and was treated conservatively. Genetic testing was not possible due to the high prohibitive cost. However, screening of the family members by MRI was recommended.

Cranial MRI of the immediate family members was performed. Four brothers of the patient and his mother were found to have multiple cavernous angiomas. The father, youngest brother, and his younger sister were found not to have any such lesion. Both children of the patient were also found to be free of these lesions. Incidentally, a meningioma was found in the father of the patient. Read more »

*This blog post was originally published at AJNR Blog*

Meditation: How It May Change The Brain

Meditation sounds like a great idea from the perspective of a psychiatrist: Anything that calms and focuses the mind is a good thing (and without pharmaceuticals, even better).

Personally, I tried transcendental meditation as a kid (more to do with my mother than with me) and found it to be boring. I have trouble keeping my thoughts still. They wander to what I want for dinner, and should I write about this on Shrink Rap, and will Clink and Victor ever eat crabcakes with me again, and did I remember to give my last patient informed consent, and a zillion other things. Holding my thoughts still is work.

The New York Times Well blog has an article on meditation and brain changes. In “How Meditation May Change the Brain,” Sindya N. Bhanoo writes:

The researchers report that those who meditated for about 30 minutes a day for eight weeks had measurable changes in gray-matter density in parts of the brain associated with memory, sense of self, empathy and stress. The findings will appear in the Jan. 30 issue of Psychiatry Research: Neuroimaging.

M.R.I. brain scans taken before and after the participants’ meditation regimen found increased gray matter in the hippocampus, an area important for learning and memory. The images also showed a reduction of gray matter in the amygdala, a region connected to anxiety and stress. A control group that did not practice meditation showed no such changes.

Lower stress, lower blood pressure, higher empathy. I may have to give meditation another try.

*This blog post was originally published at Shrink Rap*

Kids With Dyslexia: Predicting Their Reading Skills With MRI

An international team of researchers has developed a rather reliable test that predicts the future improvement of reading abilities in kids with dyslexia. The method uses functional MRI (fMRI) and diffusion tensor magnetic resonance imaging (DTI) to scan the brain, and data crunching software to interpret the data. The researchers hope that the finding will help parents and therapists uniquely identify which learning tools are best for each child.

From the announcement by Vanderbilt University :

The 45 children who took part in the study ranged in age from 11 to 14 years old. Each child first took a battery of tests to determine their reading abilities. Based on these tests, the researchers classified 25 children as having dyslexia, which means that they exhibited significant difficulty learning to read despite having typical intelligence, vision and hearing and access to typical reading instruction.

During the fMRI scan, the youths were shown pairs of printed words and asked to identify pairs that rhymed, even though they might be spelled differently. The researchers investigated activity patterns in a brain area on the right side of the head, near the temple, known as the right inferior frontal gyrus, noting that some of the children with dyslexia activated this area much more than others. DTI scans of these same children revealed stronger connections in the right superior longitudinal fasciculus, a network of brain fibers linking the front and rear of brain. Read more »

*This blog post was originally published at Medgadget*

The Musician’s Brain On MRI

Dr. Charles Limb is an otolaryngologist, and he’s also on the faculty at the Peabody Conservatory of Music. Wanting to study creativity on the neurological level, he used fMRI to scan the brains of musicians while improvising along with them. Here he describes the experiment, including the building of an MRI-compatible electronic keyboard:

Link @ TED…

*This blog post was originally published at Medgadget*

Health And The Value Of Open-Mindedness

Three recent sto­ries lead me to my open­ing topic for the year: The value of open-mindedness. This char­ac­ter­is­tic — a state of recep­tive­ness to new ideas — affects how we per­ceive and process infor­ma­tion. It’s a qual­ity I look for in my doc­tors, and which I admire espe­cially in older people.

Piece #1 — On the brain’s matu­rity, flex­i­bil­ity and “cog­ni­tive fitness”

For the first piece, I’ll note a Dec 31 op-ed piece that appeared in the New York Times: This Year, Change Your Mind, by Dr. Oliver Sacks, the neu­rol­o­gist and author. In this thought­ful essay, he con­sid­ers the adult brain’s “mys­te­ri­ous and extra­or­di­nary” power to adapt and grow: “I have seen hun­dreds of patients with var­i­ous deficits — strokes, Parkinson’s and even demen­tia — learn to do things in new ways, whether con­sciously or uncon­sciously, to work around those deficits.”

With appro­pri­ate and very-real respect, I ques­tion Sacks’ objec­tiv­ity on this sub­ject — he’s referred some of the most out­stand­ing (i.e. excep­tional) neu­ro­log­i­cal cases in the world. And so it may be that his care­ful reports are per­fectly valid but not rep­re­sen­ta­tive; for most of us, the adult brain’s capac­ity to estab­lish new cir­cuitry for lan­guage learn­ing or music appre­ci­a­tion may be lim­ited. What his sto­ries do show is that unimag­in­ably strange things hap­pen in our brains, at least occa­sion­ally. And maybe we should just accept that and take notes (as he does so care­fully), and keep an open mind. Read more »

*This blog post was originally published at Medical Lessons*

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Latest Book Reviews

Book Review: Is Empathy Learned By Faking It Till It’s Real?

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The Spirit Of The Place: Samuel Shem’s New Book May Depress You

When I was in medical school I read Samuel Shem s House Of God as a right of passage. At the time I found it to be a cynical yet eerily accurate portrayal of the underbelly of academic medicine. I gained comfort from its gallows humor and it made me…

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Eat To Save Your Life: Another Half-True Diet Book

I am hesitant to review diet books because they are so often a tangled mess of fact and fiction. Teasing out their truth from falsehood is about as exhausting as delousing a long-haired elementary school student. However after being approached by the authors’ PR agency with the promise of a…

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