COMMON MAGNETIC RESONANCE IMAGING FINDINGS IN PATIENTS WITH NEUROLOGIC DISORDERS, (UNIVERSITY OF ILORIN TEACHING HOSPITAL, KWARA STATE.)

ABSTRACT

Objective: To evaluate the common MRI findings in patients with neurologic disorders.

Method: A retrospective study of 106 patients with neurologic disorders was carried out and their respective findings carefully tabulated according to their age and sex.

Results: MRI showed small multifocal lesions hyperintense on T2 weighted images and FLAIR, with mild or nogadolinium enhancement, mainly in periventricular and subcortical regions, myelopaties in the cervical spines of some patients, white matter abnormalities above all other findings.

Conclusion: It is important to emphasize the role of MRI in the diagnosis and follow-up of these patients.Lesions that are better detected in MRI include hippocampal sclerosis and T2 hyperintensities that form the bulk of abnormalities in the pediatric category. Majority of abnormalities in the adult category like space occupying lesions can be easily picked up by CT whereas refractory seizure, cases with EEG findings suggesting TLE, suspected stroke should preferably undergo MRI brain imaging as    it is much more sensitive in detecting these pathological substrates.

TABLE OF CONTENTS

Title page……………………………………………………………………..i

Dedication………………………………………………………………………ii

Acknowledgement……………………………………………………………….iii

Approval page……………………………………………………………………..iv

Certification………………………………………………………………………v

Abstract …………………………………………………………………………vi

List of tables……………………………………………………………………..vii

CHAPTER ONE

1.1 BACKGROUND OF STUDY…………………………………………….1

1.2 statement of problems………………………………………………………..3

1.3 general objective…………………………………………………………..3

1.4 specific objectives of study………………………………………………..4

1.5 significance of study………………………………………………………4

1.6 scope of study……………………………………………………………..4

1.7 review of related literatures………………………………………………5

1.7.1 Review on the MRI findings in crohn’s disease.………………………5

1.7.2 Mri findings in neuroferritinopathy…………………………………..6

1.7.3MRI findings in 77 Children with Non-Syndromic Autistic Disorder                  …………………………………………………………………………………..12

1.7.4 Stroke……………………………………………………………………26

1.7.5 Research and development agenda……………………………………36

1.7.6 Missed opportunities…………………………………………………..38

CHAPTER TWO.

2.1Definitionof terms………………………………………………….18

2.2 Basic MRI scans……………………………………………………21

2.3   Specialized MRI scans………………………………..………………… 22

2.4Magnetization transfer MRI…………………………………….……….24

2.5 Interventional MRI……………………………………….…………………25

2.6  Radiationtherapy simulation……………..…………………………….26

2.7 Other specialized MRI techniques…………………………………………27

2.8  Safety………………………………………………..………………………..56

2.9Neuroanatomy……………………………….……………………………34

CHAPTER THREE

3.1 Research design………………………….…………………………………..46

3.2 Area of study…………………..……………………………………………46

3.3 Target population………………………………………………….………46

3.4 Selection criteria……………………………………………………………..46

3.4.1 Inclusion criteria…………………………………………………………..47

3.4.2 Exclusion criteria……………………………………………………….….47

3.5 Sampling……………………………………………………….…………….48

3.5.1 Sampling method…………………………………………………………..48

3.5.2 Sampling procedure…………………………………………………….…48

3.5.3 Sample size: ……………………………………………………..…………51

3.6 Procedure of data collection:……………………………………….52 Methods of data analysis…………………………………………………………52

CHAPTER FOUR………………………………….……………………………53

CHAPTER FIVE ………………………………………….…………………….70

CHAPTER ONE

1. BACKGROUND OF STUDY

Neurological disorders are diseases of the central and peripheral nervous system. In other words, the brain, spinal cord, cranial nerves, peripheral nerves, nerve roots, autonomic nervous system, neuromuscular junction, and muscles. These disorders include epilepsy, Alzheimer disease and other dementias, cerebrovascular diseases including stroke, migraine and other headache disorders, multiple sclerosis, Parkinson’s disease, neuroinfections, brain tumors, traumatic disorders of the nervous system such as brain trauma, and neurological disorders as a result of malnutrition. ^[8]

Hundreds of millions of people worldwide are affected by neurological disorders: For example, 50 million people have epilepsy; 62 million are affected by cerebrovascular disease; 326 million people suffer from migraine; 24 million are affected by Alzheimer disease and other dementias globally.^[4]

MRI is helpful in the evaluation of patients with clinical evidence of neurologic disorders. In most patients MRI is abnormal; Lesions are more likely to occur in the brain stem, basal ganglia, thalamus, internal capsule and spinal cord. When compared to CT, MRI has been found to better delineate lesions seen on CT in addition to show lesions not usually seen on CT. CT lesions in neurologic disorders may reflect a reversible breakdown in the blood-brain barrier, possibly related to inflammation rather than gliosis or infarction^. On the other hand, the presence of focal findings on MRI implies true cerebral disease, which is an important point in differentiating drug effects or primary psychiatric illness^.[10]

The development of anatomical neuroimagingenabled the in vivo visualization of neuropathology in conditions such as stroke, facilitating differential diagnoses and early treatment. Since then scanning techniques have gone beyond structural detail to provide images relating to human brain function, and in the past decade these techniques have been joined by an impressive new imaging tool, functional magnetic resonance imaging (functional MRI). This has a spatial resolution within the millimeter scale and can capture responses in the brain occurring over a few seconds, although reconstruction and processing of the raw data commonly occur after scanning. ^[10]

Also, Functional MRI is non­invasive and safe. It does not require radioactive tracer substances, unlike positronemission tomography (PET) or single photon emission tomography (SPET), and uses the brain’s natural hemodynamic response to neural activity as an endogenous tracer. It can be carried out during the same session as routine magnetic resonance imaging in a clinical scanner. These features are making it increasingly popular in neuropsychiatric research.The commonest form of functional MRI is blood oxygenation level dependent (BOLD) imaging.1 The BOLD signal depends on the ratio of oxygenated to deoxygenatedhemoglobin. ^[11]

1.2 STATEMENT OF PROBLEMS.

1. The mostcommon Magnetic Resonance Imaging findings in patients with neurologic disorders has not been documented in our locality.
2. The diagnostic yields of MRI in neurologic disorders have not been evaluated in our locality.
3. The age range at which certain neurologic disorders manifest more in have not been documented in our locality.
4. As neurologic disorders are the disorders that occur in the brain and spinal cord, the particular part of the CNS where neurologic disorders manifest more in, has not been document in our locality.

1.3 GENERAL OBJECTIVE.

To evaluatethe common MRI findings in patients with neurologic disorders.

1.4 SPECIFIC OBJECTIVES OF STUDY.

1. To characterize the MRI findings in patients presenting with neurologic disorders.
2. To evaluate the prevalence of common neurologic disorders using MRI.
3. To determine the age range at which neurologic disorders manifest more.
4. To determine the particular part of the CNS where neurologic disorders manifest more.
5. To evaluate the diagnostic yield of MRI in the diagnosis of neurologic disorders.

1.5SIGNIFICANCE OF STUDY.

1. The study will characterize the MRI findings in selected patients with neurologic disorders in UITH (University of Ilorin Teaching Hospital).
2. The study will provide data on the prevalence of common neurologic disorders using MRI in our locality.
3. The study will evaluate the significance of MRI in the diagnosis of neurologic disorders.
4. The study will provide data on the age range at which neurologic disorders manifest more in our locality.
5. The study will provide data on the particular part of the CNS where neurologic disorders manifest more.
6. The study will also evaluate the diagnostic yield of MRI in neurologic disorders.

1.6SCOPE OF STUDY.

This retrospective study will involve all categories of patients as regards to age, sex, body type and race presented with neurologic disorders in UITH (University of Ilorin Teaching Hospital.

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