Source: About Wessam Bou-Assaly
Autism and Brain MRI
Wessam Bou-Assaly, MD
A national research network led by UNC School of Medicine’s Joseph Piven, MD, found
that many toddlers diagnosed with autism at two years of age had a substantially greater
amount of extra-axial cerebrospinal fluid (CSF) at six and 12 months of age, before
diagnosis is possible. They also found that the more CSF at six months — as measured
through MRIs — the more severe the autism symptoms were at two years of age.
Until the last decade, the scientific and medical communities viewed CSF as merely a
protective layer of fluid between the brain and skull, not necessarily important for
proper brain development and behavioral health. But scientists then discovered that
CSF acted as a crucial filtration system for byproducts of brain metabolism.
Every day, brain cells communicate with each other. These communications cause brain
cells to continuously secrete byproducts, such as inflammatory proteins that must be
filtered out several times a day. The CSF handles this, and then it is replenished with
fresh CSF four times a day in babies and adults.
The researchers found that increased CSF predicted with nearly 70 percent accuracy
which babies would later be diagnosed with autism. It is not a perfect predictor of autism, but the CSF differences are observable on a standard MRI. “
Different Types of Dementia
Wessam Bou-Assaly, MD
AD is a chronic neurodegenerative disease that usually has a progressive worsening course. It is characterized by loss of neurons and synapses in the cerebral cortex, resulting in gross atrophy of the affected regions, mainly the temporal and parietal lobes and parts of the frontal cortex and cingulate gyrus.
It is the cause of 60% to 70% of cases of dementia.
The most common early symptom is difficulty in remembering recent events ( short-memory loss). As the disease advances, symptoms can include problems in language, disorientation (including easily getting lost), mood swings, loss of motivation, not managing self care, and behavioral issues. The patients often withdraw from family and society.
Gradually, bodily functions are lost, ultimately leading to death.
Although the speed of progression can vary, the average life expectancy following diagnosis is three to nine years.
The cause of Alzheimer’s disease is poorly understood.. About 70% of the risk is believed to be genetic with many genes usually involved. Other risk factors include a history of head injury, depression or hypertension.
Frontotemporal dementia ( Pick’s Disease)
Frontotemporal dementia ( also known as Pick’s disease or frontotemporal lobar degeneration) primarily affect the frontal and/or temporal lobes of the brain and are generally associated with personality and behavior.
In frontotemporal dementia, portions of these lobes atrophy. Clinical features are early personality and behavioral changes ( Disinhibition, euphoria, apathy), Compulsive behaviors (peculiar eating, habits), executive disfunction and later appearance of memory deficits. The dramatic changes in the personality is associated with socially inappropriate, impulsive or emotionally blunted behaviors.
Frontotemporal dementia is often misdiagnosed as a psychiatric problem or as Alzheimer’s disease, but it tends to occur at a younger age than does Alzheimer’s disease, typically between the ages of 40 and 70, with a more delayed occurrence of memory problems.
Dementia with Lewy Bodies
Dementia with Lewy bodies (DLB) is one of the most common types of progressive dementia.
The central feature of DLB is progressive cognitive decline, combined with three additional defining features:
1- Visual hallucinations.
2- Fluctuations in alertness and attention, often leading to misdiagnose as delirium. ( frequent drowsiness, lethargy, lengthy periods of time spent staring into space, or disorganized speech;
3-Parkinsonian motor symptoms, such as rigidity and the loss of spontaneous movement.
People may also suffer from depression. The symptoms of DLB are caused by the build-up of Lewy bodies (alpha-synuclein protein) inside the nuclei of neurons in areas of the brain that control particular aspects of memory and motor control.
The similarity of symptoms between DLB and Parkinson’s disease, and between DLB and Alzheimer’s disease, can often make it difficult for a doctor to make a definitive diagnosis. In addition, Lewy bodies are often also found in the brains of people with Parkinson’s and Alzheimer’s diseases. These findings suggest that either DLB is related to these other causes of dementia or that an individual can have both diseases at the same time. DLB usually occurs sporadically, in people with no known family history of the disease. However, rare familial cases have occasionally been reported.
Normal Pressure Hydrocephalus
Normal pressure hydrocephalus (NPH) is a form of hydrocephalus( Dilated ventricles).
It can occur without a known cause, or it may be caused by any condition that blocks the flow of cerebrospinal fluid (CSF), resulting in increased volume of CSF in the ventricles.
Ataxia ( lack of voluntary coordination) and urinary incontinence appear early in the disease. The dementia symptoms of NPH can be similar to those of Alzheimer’s disease.
NPH can be reversed in many people with appropriate treatment. But first it must be correctly diagnosed. NPH is thought to account for about 5% of all dementias.
Vascular dementia is an umbrella term that describes impairments in cognitive function caused by problems in the brain blood vessels. It accounts for 15-20 % of dementia cases and the risk increases dramatically with age.
Risk factors for cerebrovascular disease include hypertension, hyperlipidemia, smoking diabetes.
Usually there is stepwise decline in memory, with early executive dysfunction. Cerebral infarcts or white matter changes are seen on MRI.
Creutzfeldt-Jakob Disease or Prion disease
Creutzfeldt-Jakob disease (CJD) is a rare, degenerative, fatal brain disorder. It affects about one person in every one million people per year worldwide.
CJD usually appears in later life and runs a rapid course. Typically, onset of symptoms occurs about age 60, and about 90 percent of patients die within 1 year.
The disease is characterized by behavioral changes, rapidly progressive memory problems with myoclonus and seizures.
As the illness progresses, mental deterioration becomes pronounced and involuntary movements, blindness, weakness of extremities, and coma may occur.
Wernicke-Korsakoff syndrome is caused by a thiamine ( Vitamin B1) deficiency.
It involves damage to multiple nerves in both the central nervous system (brain and spinal cord) and the peripheral nervous system.
The cause is generally attributed to malnutrition, especially lack of vitamin B1 (thiamin), which is common in those with alcoholism. Heavy alcohol use interferes with the breakdown of thiamin in the body, so even if someone with alcoholism follows a well-balanced diet, most of the thiamin is not absorbed.
Wessam Bou-Assaly, MD is a Radiologist specialized in Neuroradiology and Head and Neck Imaging.
As an avid tennis fan who loves to follow the game as much as he likes to play it, Wessam Bou-Assaly appreciates the special sporting event that the Wimbledon Grand Slam is every year. When asked to pick the best, most prestigious one out of the four Grand Slams, most people usually mention Wimbledon, and they probably have very good – and valid – reasons to do that.
For starters, Wimbledon is the oldest out of the four, having been founded in 1877, four years before the US Open. While its age is important, that’s not the only reason for this distinction. The other – and probably more important – is its status. Until the 1924/1925 season, Wimbledon was the only Grand Slam tournament. It was only that year when the other three tournaments (Australian Open, French Open, and US Open) have joined Wimbledon in the rankings, starting a new era in tennis.
Played on Grass
There is just something majestic about grass. Maybe it’s the fact that grass courts are – by far – the rarest out of all surfaces. There are not a whole lot of grass courts around the world, certainly not if we go by professional standards.
The fact that it is played in London, often in the courtesy of one or more members of the royal family, doesn’t hurt its case either. Even the Queen has attended the tournament in recent years, several decades after her previous visit which took place in 1977. As a big fan of the game, Wessam Bou-Assaly appreciates the role that Wimbledon plays in the tennis world.
Brain imaging with MRI, SPECT, and PET can improve diagnostic accuracy in differentiating Alzheimer Disease (AD) from potentially treatable causes of dementia such as toxic metabolic states, depression, and normal pressure hydrocephalus. When PET results are combined with clinical criteria, the false positive rate in AD can be reduced from 23% to 11%. The classic pattern of AD on PET imaging is bilateral temporoparietal and posterior cingulate cortex hypometabolism; abnormal metabolism can also be seen asymmetrically, particularl yearly in the disease. Frontal lobe involvement may also be seen in later stages. The exact cause for the decline in brain glucose metabolism in AD remains unclear. Hippocampal atrophy may be seen on conventional cross-sectional imaging.
Dementia With Lewy Bodies ( DLB) is another cause of cognitive decline. Patients with DLB usually have less hippocampal atrophy than do patients with Alzheimer disease and show decreased occipital lobe blood flow or metabolism in DLB but not in Alzheimer disease.
In frontotemporal dementia, frontal and anterior temporal metabolism is predominantly decreased compared to the other types of dementia
Wessam Bou-Assaly is an experienced Neuroradiologist who practices in Ann Arbor Michigan.