Thursday, April 10, 2008


Arteriovenous Shunt Visualization in Arteriovenous Malformations with Arterial Spin-Labeling MR Imaging
R.L. Wolfa, J. Wanga,b, J.A. Detrea,b, E.L. Zagerc and R.W. Hursta,c

a Department of Radiology, University of Pennsylvania Medical Center, Philadelphia, Pa
b Department of Neurology, University of Pennsylvania Medical Center, Philadelphia, Pa
c Department of Neurosurgery, University of Pennsylvania Medical Center, Philadelphia, Pa

Please address correspondence to Ronald L. Wolf, MD, PhD, University of Pennsylvania Medical Center, Department of Radiology, Section of Neuroradiology, Dulles 219, 3400 Spruce St, Philadelphia, PA 19104; e-mail:

BACKGROUND AND PURPOSE: A reliable quantitative technique for measuring arteriovenous (AV) shunt in vascular malformations is not currently available. Here, we evaluated the hypothesis that continuous arterial spin-labeled (CASL) perfusion MR imaging can be used to detect and measure AV shunt in patients with arteriovenous malformations (AVMs).

MATERIALS AND METHODS: CASL perfusion MR imaging was performed in 7 patients with AVMs. Semiquantitative AV shunt estimates were generated based on a thresholding strategy by using signal-intensity difference ({Delta}M) images to avoid potential errors in cerebral blood flow (CBF) calculation related to abnormal transit times and nonphysiologic blood-tissue water exchange in and around the AVMs. The potential for measuring CBF in regions distant from and near the AVM was explored, as was the relationship of CBF changes related to the size of the shunt.

RESULTS: In all 7 cases, striking increased intensity was seen on CASL perfusion {Delta}M maps in the nidus and venous structures draining the AVM. Shunt estimates ranged from 30% to 0.6%. Mean CBF measurements in structures near the AVMs were not significantly different from the contralateral measurements. However, CBF in adjacent ipsilateral white matter increased relative to the contralateral side as the percent shunt increased (P = .02). Cortical gray matter CBF {Delta} (contralateral-ipsilateral) values demonstrated the same effect, but the correlation was weak and not significant. Thalamic CBF decreased ipsilaterally with increasing percent AV shunt (P = .01), indicating a possible steal effect. Basal ganglia {Delta} values showed little change in CBF with the size of the AV shunt.

CONCLUSION: CASL perfusion MR imaging can demonstrate AV shunting, providing high lesion conspicuity and a novel means for evaluating AVM physiology.


"Idol" inspires


Tonight is the second annual Idol Gives Back special on American Idol, and it promises to be a celebrity-studded event. Due to the success of last year's event, it is going to be longer, it has brought in even bigger performers and more corporate sponsors. Idol producers have set a goal of $100 million in donations and pledges — $25 million more than last year's total.

But I'm getting ahead of myself, because there were performances last night, to the tune of “inspirational songs.” And I have to admit that for the first time all season, I don't have any major complaints!

Syesha Mercado got things started for the ladies by singing former Idol winner Fantasia Barrino's first single, “I Believe.” Randy may have thought she got in over her head on the performance, but I begrudgingly agree with Paula Abdul's grammatically correct yet awkward statement, “I just think hands down this is one of your most shining nights.”

get the rest....

Tuesday, April 08, 2008

An Energy Collage

An Energy Collage
Don't miss Jill Bolte Taylor, a neuroanatomist, talking about her stroke at TED. She's dynamic and what she has to say is fascinating for anyone with a brain, literally.

I love her distinctions between the left and right hemispheres, which are quite different from anything I had read or heard before about their differences. She describes the left hemisphere of the brain as working like a serial port, linear and methodical, and the right side as working like a parallel port, experiencing everything as a sort of sensory energy collage. Then (here's where it gets interesting), she says that the right side is 'in the moment' all the time, and thus in the flow of what is happening now, in flow with all other energy on the planet, so that there are no boundaries, no separation between things, and everything is present tense, sensory, elemental, energy. The left side takes this energy collage it's presented with and immediately begins a process of categorising and organising the data, relating it to the experience of the past and the potential of the future.

She also says that the left brain is where the sense of "I" is, the ego, the idea that "I" am separate from other things, originates: The left side is "that little voice that says to me, 'I am. I am.' And as soon as my left hemisphere says to me 'I am,' I become separate. I become a single solid individual separate from the energy flow around me and separate from you." From the right brain's perspective, 'I'm' in the flow with all other energy, not a separate entity with boundaries.

(I can't help but consider this from a Girardian perspective, from the very basic rivalry/mimesis of self and other that Girard posits and which feels true to my experience and observation -- why does the left brain have so much authority for most of us, for culture? Her comments also make me think of G-d's "I am that I am" or "I shall be that I shall be" when Moses asks G-d's name -- is that a separation-making statement or is it an expansion of self into all things?)

Jill's stroke affected her left side, shutting it down, so that even in the early minutes of it she couldn't see where her arm ended and the wall began, because there weren't boundaries between the two: "Because the atoms and the molecules of my arm blended with the atoms and molecules of the wall. And all I could detect was this energy." She couldn't read her business card because she could only see the pixels that make up the lettering and numbers, and she couldn't make meaning of the pixels. She spent a lot of time trying to match the shape of the squiggles she could see on the card to the shape of the squiggles on the telephone dial (so she could call her office for help). This reminds me of dreams I've had, with episodes exactly like this.

Her description of finding nirvana in the hospital -- a huge feeling of expansiveness, an overwhelming sense of peace -- reminds me of how people sometimes talk about the psychosis that is mania; and it also reminds me of how I have felt near the ocean, on the beach sifting sand through my hands, watching birds, in gardens, meditating, dreaming, writing (even though it's using language, that left-brain tool), looking at art (there was a modern painting on the lower level of the National Gallery's East Wing that affected me this way in February, and I don't know what it was called or who painted it), listening to music, watching movies, in conversation with someone, making love. It's how I almost always feel when travelling on the train.

Jill's talk ends this way:

"So who are we? We are the life force power of the universe, with manual dexterity and two cognitive minds. And we have the power to choose, moment by moment, who and how we want to be in the world. Right here right now, I can step into the consciousness of my right hemisphere where we are -- I am -- the life force power of the universe, and the life force power of the 50 trillion beautiful molecular geniuses that make up my form. At one with all that is. Or I can choose to step into the consciousness of my left hemisphere. where I become a single individual, a solid, separate from the flow, separate from you. I am Dr. Jill Bolte Taylor, intellectual, neuroanatomist. These are the 'we' inside of me.

"Which would you choose? Which do you choose? And when? I believe that the more time we spend choosing to run the deep inner peace circuitry of our right hemispheres, the more peace we will project into the world and the more peaceful our planet will be. And I thought that was an idea worth spreading."

A powerful message.

The transcript is here but the video is better.

Jill's website is here.

(For 'Six Feet Under' fans: Jill had the same kind of stroke that Nate Fisher had, an AVM)

Monday, April 07, 2008

Brain malformation

Brain malformation

FDA Grants Approval to First (?) Digital Mammograph With Computer Aided Detection

Brain Aneurysm and Arteriovenous Malformation Center at MGH …
For patients with aneurysms and arteriovenous malformations (AVMs) as well as other neurovascular problems of the brain and spinal cord. …

Head and Brain Malformations Health Topic - Medicine Online
Medical information on Head and Brain Malformations, Head and Brain Malformations From the National Institutes of Health, Head and Brain Malformations …

icad inc. has announced that the fda approved the integration of its secondlook digital tumor detection system with fuji’s fcrm tomograph. icad claims it is the first implementation of computer aided detection technology on top of a digital mammography modus operandi, although medgadget covered siemens’ announcement of icad’s integration into its systems two years ago.

Chiari Malformation Information Page: National Institute of …
Chiari malformations (CMs) are structural defects in the cerebellum, the part of the brain that controls balance. When the indented bony space at the lower …

eMedicine - Brain, Arteriovenous Malformation : Article by Robert …
An arteriovenous malformation (AVM) is a tangled cluster of vessels, typically located supratentorially, in which arteri.

MedlinePlus: Head and Brain Malformations
The primary NIH organization for research on Head and Brain Malformations is the National Institute of Neurological Disorders and Stroke …

from the outcome brochure: the unique secondlook algorithms detect up to 72% of actionable missed cancers an average of 15 months earlier than screening mammography alone. potential cancers are identified using patented high-sounding astuteness and pattern cognizance technology to analyze images and identify patterns. sophisticated arithmetical analysis identifies and marks suspicious areas without obscuring the underlying image, enabling faster, more accurate reading.

SecondLook Digital provides the most powerful and flexible DICOM connectivity solutions – enhancing digital workflow and enabling seamless integration with acquisition systems, review workstations, and PACS from leading vendors. Flexible integration options enable CAD results to be viewed on workstations or sent to a plain paper printer. Priority queuing of studies improves clinical efficiency and efficacy by enabling the most urgent or important studies to be analyzed with CAD first. SecondLook Digital performs CAD analysis on an image in an average of up to just 30 seconds, maximizing throughput and preventing bottlenecks.

read original...

jes, youd think i had an obsion....

Why Zombies Will Not Eat My Brain

Why Zombies Will Not Eat My Brain
My father passed away tragically on 27 January 2008, one day before his 51st birthday. He died of a stroke caused by a brain hemorrhage. Twenty-five years prior, my dad suffered a brain hemorrhage and a stroke. He was born with an AVM (arteriovascular malformation) which is when your blood vessels are basically in a knot. He was a ticking time bomb. The fact that he hit his head almost daily (he was 6’5" and was stationed on a submarine) did not help. AVMs can be genetic. Ever since I turned 25, I have feared my 26th birthday because my dad was 26 when he had his brain trauma. The day he died made me fear my age even more. It also made me spring into action and call my doctor. I got my MRI and I went to the doctor last week to get my results. The Good News is that I DON’T have an AVM. YAY!!! The Bad News is that I have FMD (Fibromuscular Dysplasia). Basically I have a blood vessel in my brain that looks like a string of pearls. This weakens the blood vessel and increases my chances of developing more serious problems such as aneurysm or hemorrhage. Luckily, if I quit smoking, eat right, exercise, and keep my stress level down, I will have no ill effects. I also need to go to the hospital for further testing. I need a PDA (Power Doppler Angiogram) test to confirm my diagnosis. I’m just glad that I do not have an AVM and that I don’t have an aneurysm. My brother Michael is also going to the doctor because he is getting bad headaches.

Brain surgery

More about brain arteriovenous malformation hemorrhage and rehemorrhage.
The peak age for hemorrhage from an AVM is somewhere in the late teens (age 15-20 yrs). There is a 10% instant mortality associated with the first hemorrhage, and up to 30% mortality associated with each rebleed (rehemorrhage). The first hemorrhage has a 30-50% chance of causing some neurological impairment (deficit). The hemorrhage itself is usually within the substance of the brain (intraparenychmal hemorrhage), but also may be subarachnoid (outer or under surfaces of the brain), or within the fluid filled spaces of the brain (intraventricular), or just under the leather covering of the brain (subdural).
Some tendencies regarding hemorrhage are the following (subject to debate): the hemorrhage rate may be higher in the following: (i) kids; (ii) AVMs located in the back portion of the brain (hindbrain, posterior fossa); (iii) smaller AVMs (?higher pressure in these); (iv) pregnancy.
Hemorrhage rates: The average (annual) rate of hemorrhage for a newly diagnosed AVM that has not bled before is somewhere between 2-4% per year. The mean time between diagnosis of an AVM and first hemorrhage is somewhere around 7-8 years, but this obviously varies from person to person. The chance of death with a newly diagnosed AVM is approximately 1% per year, much higher after hemorrhage as mentioned above.
The risk of hemorrhage from the AVM itself after treatment with radiation (e.g., stereotactic radiosurgery such as GammaKnife or LINAC) is not reduced, in fact may be slightly higher than normal AVM hemorrhage rates, till the AVM is completely obliterated by such treatment (which can take 2-3 years).
Rehemorrhage rates: Depending on what you read, the (annual) rehemorrhage rate from an AVM (i.e., the chance of second bleed) is somewhere between 6-18% in the first year following diagnosis. Over the next few years, this rate decreases to somewhere around 3-4% per year. As mentioned above, rehemorrhage carries a very high rate of death and permanent disability.