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Raininko, Raili
Publications (10 of 63) Show all publications
Wallin, E., Larsson, I.-M., Kristofferzon, M.-L., Larsson, E.-M., Raininko, R. & Rubertsson, S. (2018). Acute brain lesions on magnetic resonance imaging in relation to neurological outcome after cardiac arrest. Acta Anaesthesiologica Scandinavica, 62(5), 635-647
Open this publication in new window or tab >>Acute brain lesions on magnetic resonance imaging in relation to neurological outcome after cardiac arrest
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2018 (English)In: Acta Anaesthesiologica Scandinavica, ISSN 0001-5172, E-ISSN 1399-6576, Vol. 62, no 5, p. 635-647Article in journal (Refereed) Published
Abstract [en]

BACKGROUND:

Magnetic resonance imaging (MRI) of the brain including diffusion-weighted imaging (DWI) is reported to have high prognostic accuracy in unconscious post-cardiac arrest (CA) patients. We documented acute MRI findings in the brain in both conscious and unconscious post-CA patients treated with target temperature management (TTM) at 32-34°C for 24 h as well as the relation to patients' neurological outcome after 6 months.

METHODS:

A prospective observational study with MRI was performed regardless of the level of consciousness in post-CA patients treated with TTM. Neurological outcome was assessed using the Cerebral Performance Categories scale and dichotomized into good and poor outcome.

RESULTS:

Forty-six patients underwent MRI at 3-5 days post-CA. Patients with good outcome had minor, mainly frontal and parietal, lesions. Acute hypoxic/ischemic lesions on MRI including DWI were more common in patients with poor outcome (P = 0.007). These lesions affected mostly gray matter (deep or cortical), with or without involvement of the underlying white matter. Lesions in the occipital and temporal lobes, deep gray matter and cerebellum showed strongest associations with poor outcome. Decreased apparent diffusion coefficient, was more common in patients with poor outcome.

CONCLUSIONS:

Extensive acute hypoxic/ischemic MRI lesions in the cortical regions, deep gray matter and cerebellum detected by visual analysis as well as low apparent diffusion coefficient values from quantitative measurements were associated with poor outcome. Patients with good outcome had minor hypoxic/ischemic changes, mainly in the frontal and parietal lobes.

National Category
Anesthesiology and Intensive Care
Identifiers
urn:nbn:se:uu:diva-340789 (URN)10.1111/aas.13074 (DOI)000429532400007 ()29363101 (PubMedID)
Available from: 2018-02-02 Created: 2018-02-02 Last updated: 2018-06-19Bibliographically approved
Abu Hamdeh, S., Marklund, N., Lannsjö, M., Howells, T., Raininko, R., Wikström, J. & Enblad, P. (2017). Extended anatomical grading in diffuse axonal injury using MRI: Hemorrhagic lesions in the substantia nigra and mesencephalic tegmentum indicate poor long-term outcome. Journal of Neurotrauma, 5(34), 341-352
Open this publication in new window or tab >>Extended anatomical grading in diffuse axonal injury using MRI: Hemorrhagic lesions in the substantia nigra and mesencephalic tegmentum indicate poor long-term outcome
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2017 (English)In: Journal of Neurotrauma, ISSN 0897-7151, E-ISSN 1557-9042, Vol. 5, no 34, p. 341-352Article in journal (Refereed) Published
Abstract [en]

Clinical outcome after traumatic diffuse axonal injury (DAI) is difficult to predict. In this study, three magnetic resonance imaging (MRI) sequences were used to quantify the anatomical distribution of lesions, to grade DAI according to the Adams grading system, and to evaluate the value of lesion localization in combination with clinical prognostic factors to improve outcome prediction. Thirty patients (mean 31.2 years ±14.3 standard deviation) with severe DAI (Glasgow Motor Score [GMS] <6) examined with MRI within 1 week post-injury were included. Diffusion-weighted (DW), T2*-weighted gradient echo and susceptibility-weighted (SWI) sequences were used. Extended Glasgow outcome score was assessed after 6 months. Number of DW lesions in the thalamus, basal ganglia, and internal capsule and number of SWI lesions in the mesencephalon correlated significantly with outcome in univariate analysis. Age, GMS at admission, GMS at discharge, and low proportion of good monitoring time with cerebral perfusion pressure <60 mm Hg correlated significantly with outcome in univariate analysis. Multivariate analysis revealed an independent relation with poor outcome for age (p = 0.005) and lesions in the mesencephalic region corresponding to substantia nigra and tegmentum on SWI (p  = 0.008). We conclude that higher age and lesions in substantia nigra and mesencephalic tegmentum indicate poor long-term outcome in DAI. We propose an extended MRI classification system based on four stages (stage I—hemispheric lesions, stage II—corpus callosum lesions, stage III—brainstem lesions, and stage IV—substantia nigra or mesencephalic tegmentum lesions); all are subdivided by age (≥/<30 years).

Keywords
adult brain injury, axonal injury, head trauma, MRI, susceptibility weighted imaging
National Category
Clinical Medicine Neurology
Identifiers
urn:nbn:se:uu:diva-309038 (URN)10.1089/neu.2016.4426 (DOI)000391754800009 ()27356857 (PubMedID)
Available from: 2016-12-01 Created: 2016-12-01 Last updated: 2018-02-19Bibliographically approved
Ali, Z., Klar, J., Jameel, M., Khan, K., Fatima, A., Raininko, R., . . . Dahl, N. (2016). Novel SACS mutations associated with intellectual disability, epilepsy and widespread supratentorial abnormalities. Journal of the Neurological Sciences, 371, 105-111
Open this publication in new window or tab >>Novel SACS mutations associated with intellectual disability, epilepsy and widespread supratentorial abnormalities
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2016 (English)In: Journal of the Neurological Sciences, ISSN 0022-510X, E-ISSN 1878-5883, Vol. 371, p. 105-111Article in journal (Refereed) Published
Abstract [en]

We describe eight subjects from two consanguineous families segregating with autosomal recessive childhood onset spastic ataxia, peripheral neuropathy and intellectual disability. The degree of intellectual disability varied from mild to severe and all four affected individuals in one family developed aggressive behavior and epilepsy. Using exome sequencing, we identified two novel truncating mutations (c.2656C>T (p.Gln886*)) and (c.4756_4760delAATCA (p.Asn1586Tyrfs*3)) in the SACS gene responsible for autosomal recessive spastic ataxia of Charlevoix-Saguenay (ARSACS). MRI revealed typical cerebellar and pontine changes associated with ARSACS as well as multiple supratentorial changes in both families as likely contributing factors to the cognitive symptoms. Intellectual disability and behavioral abnormalities have been reported in some cases of ARSACS but are not a part of the characteristic triad of symptoms that includes cerebellar ataxia, spasticity and peripheral neuropathy. Our combined findings bring further knowledge to the phenotypic spectrum, neurodegenerative changes and genetic variability associated with the SACS gene of clinical and diagnostic importance.

National Category
Neurology
Identifiers
urn:nbn:se:uu:diva-309036 (URN)10.1016/j.jns.2016.10.032 (DOI)000389399300024 ()27871429 (PubMedID)
Funder
Swedish Research Council, 2015-02424Science for Life Laboratory - a national resource center for high-throughput molecular bioscience
Available from: 2016-12-01 Created: 2016-12-01 Last updated: 2017-11-29Bibliographically approved
Wallin, E., Rubertsson, S., Larsson, I.-M., Kristoferzon, M.-L., Larsson, E.-M. & Raininko, R. (2016). Relationship of acute brain lesions on MRI after cardiac arrest treated with hypothermia to neurological outcome 6 months later. In: Insights into Imaging 7:Suppl 1, 2016: . Paper presented at ECR 2016. Springer, 7, Article ID B-0813.
Open this publication in new window or tab >>Relationship of acute brain lesions on MRI after cardiac arrest treated with hypothermia to neurological outcome 6 months later
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2016 (English)In: Insights into Imaging 7:Suppl 1, 2016, Springer, 2016, Vol. 7, article id B-0813Conference paper, Oral presentation with published abstract (Refereed)
Abstract [en]

Relationship of acute brain lesions on MRI after cardiac arrest treated with hypothermia to neurological outcome 6 months later,

Purpose: To document the acute MRI findings in the brain of post-cardiac arrest (CA) patients treated with therapeutic hypothermia and their relationship to patient outcome after 6 months.

Methods and Materials: MRI was performed prospectively 3-13 days (median 4) after CA in 56 patients regardless of the level of consciousness in three hospitals. The images were interpreted visually by two neuroradiologists. Apparent diffusion coefficient (ADC) was measured in predetermined areas in cerebral white matter, deep grey matter,  cerebellar grey and white matter and the brainstem. Outcome was assessed using the Cerebral Performance Categories Scale (CPC ) and dichotomized into good and poor outcome.

Results: Acute hypoxic lesions on diffusion-weighted MRI (DWI) were more common in patients with poor outcome (p=0.006) and affected mostly grey matter, deep or cortical, with or without involvement of underlying white matter. Pure white matter lesions were very few. Lesions in the occipital and temporal lobes, deep white matter and cerebellum were most associated with poor outcome. Reductions in the ADC, particularly in the occipital lobes, were more common in patients with poor outcome. None of the patients with an ADC below 604-678 x10-6 mm2/s (variation depending on the equipment and technique) in any region survived to 6 months.

Conclusion: Extensive acute lesions in cortical regions and deep grey matter in visual analysis and regions with an ADC under the level 600-680 x10-6 mm2/s are associated with poor outcome. Lesions are fewer and mainly situated in the frontal and parietal lobes in patients with good outcome.

Place, publisher, year, edition, pages
Springer, 2016
Series
Insights into imaging ; vol 7:Suppl1
National Category
Radiology, Nuclear Medicine and Medical Imaging
Identifiers
urn:nbn:se:uu:diva-309040 (URN)
Conference
ECR 2016
Available from: 2016-12-01 Created: 2016-12-01 Last updated: 2017-02-17Bibliographically approved
Burman, J., Raininko, R., Blennow, K., Zetterberg, H., Axelsson, M. & Malmeström, C. (2016). YKL-40 is a CSF biomarker of intrathecal inflammation in secondary progressive multiple sclerosis.. Journal of Neuroimmunology, 292, 52-57
Open this publication in new window or tab >>YKL-40 is a CSF biomarker of intrathecal inflammation in secondary progressive multiple sclerosis.
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2016 (English)In: Journal of Neuroimmunology, ISSN 0165-5728, E-ISSN 1872-8421, Vol. 292, p. 52-57Article in journal (Refereed) Published
Abstract [en]

YKL-40 (CHI3L1) is a glycoprotein predominantly produced by reactive astrocytes in chronic active MS lesions, which are common in secondary progressive MS. In this study, YKL-40 was investigated in different stages of MS and in relation to MRI findings. YKL-40 levels in CSF samples from two independent patient cohorts of MS patients were determined with ELISA. CSF YKL-40 was increased in patients with active relapsing-remitting MS and correlated with the number of gadolinium enhancing lesions. Patients with secondary progressive MS had similar high levels of YKL-40, whereas not active relapsing-remitting MS patients had YKL-40 levels comparable to healthy controls.

National Category
Neurology
Identifiers
urn:nbn:se:uu:diva-288096 (URN)10.1016/j.jneuroim.2016.01.013 (DOI)000372561600008 ()26943959 (PubMedID)
Funder
Swedish Research CouncilTorsten Söderbergs stiftelse
Available from: 2016-04-27 Created: 2016-04-27 Last updated: 2017-11-30Bibliographically approved
Wallin, E., Larsson, I.-M., Kristofferzon, M.-L., Rubertsson, S., Larsson, E.-M. & Raininko, R. (2015). Acute brain lesions on MRI in relation to neurological outcome 6 months after cardiac arrest treated with hypothermia.. Paper presented at Congress of European Resuscitation Council 2015, Prag, Czech Republic. Resuscitation, 96(Suppl1), 147
Open this publication in new window or tab >>Acute brain lesions on MRI in relation to neurological outcome 6 months after cardiac arrest treated with hypothermia.
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2015 (English)In: Resuscitation, ISSN 0300-9572, E-ISSN 1873-1570, Vol. 96, no Suppl1, p. 147-Article in journal, Meeting abstract (Other academic) Published
Abstract [en]

Aim of the study: To document the acute magnetic resonance imaging (MRI) findings on the brain in cardiac arrest (CA) patients treated with therapeutic hypothermia (TH) and their relation to patients’ neurological outcome after 6 months.

Method: A prospective observational study with MRI was performed regardless the level of consciousness in 56 post-CA patients treated with TH.

Results: MRI of the brain was obtained at a median of 4 days  (3-13 days). At 6 months, 32/56 had survived with good neurological outcome. The MMSE was performed in 28/32 (88%) patients with a median of 28 (24-30). Acute ischemic lesions were found on diffusion-weighted MRI (DWI) in 34 (61%) patients and were more common in patients with poor outcome (p=0.006). Acute ischemic injuries affected mostly gray matter, deep or cortical and with or without involvement of the underlying white matter. Very few lesions were pure white matter lesions. Lesions in the occipital and temporal lobes, deep gray matter and cerebellum were most associated with poor outcome. Reductions in the apparent diffusion coefficient (ADC) were more common in patients with poor outcome, particularly in the occipital lobes. None of the patients with an ADC below 600x10-6 mm2/s in any region survived to 6 months.

Conclusions: In visual analyses of acute MRI, extensive acute lesions were found in the cortical regions and gray matter and were associated with poor outcome. In ADC measurements, low values were associated with poor outcome. Patients with good outcome showed a minor pathological pattern mainly in the frontal and parietal lobes.

 

Keywords
cardiac arrest, hypothermia, MRI, diffusion brain acute lesions, neurological outcome
National Category
Anesthesiology and Intensive Care Neurology Radiology, Nuclear Medicine and Medical Imaging
Research subject
Medical Science; Anaesthesiology and Intensive Care
Identifiers
urn:nbn:se:uu:diva-248025 (URN)
Conference
Congress of European Resuscitation Council 2015, Prag, Czech Republic
Available from: 2015-04-15 Created: 2015-03-26 Last updated: 2017-10-25
Hellström, J., Romanos Zapata, R., Libard, S., Alafuzoff, I., Wikström, J., Ortiz-Nieto, F. & Raininko, R. (2015). Clinical value of MR spectroscopy: How often does MRS yield more information than MRI?. Paper presented at 38th Annual Meeting of European Society of Neuroradiology, Neapel, Italy.. Neuroradiology, 57(Suppl1), 143-144
Open this publication in new window or tab >>Clinical value of MR spectroscopy: How often does MRS yield more information than MRI?
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2015 (English)In: Neuroradiology, ISSN 0028-3940, E-ISSN 1432-1920, Vol. 57, no Suppl1, p. 143-144Article in journal (Refereed) Published
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:uu:diva-264483 (URN)
Conference
38th Annual Meeting of European Society of Neuroradiology, Neapel, Italy.
Available from: 2015-10-13 Created: 2015-10-13 Last updated: 2017-12-01
Hellström, J., Romanos Zapata, R., Ortiz-Nieto, F., Libard, S., Alafuzoff, I., Wikström, J. & Raininko, R. (2015). Evaluation of INTERPRET Decision Support System (DSS) in clinical MRS of intracranial lesions and comparison to conventional MRS analysis and MRI.. Paper presented at 38th Annual Meeting of European Society of Neuroradiology, Neapel, Italy.. Neuroradiology, 57(Suppl1), 67-68
Open this publication in new window or tab >>Evaluation of INTERPRET Decision Support System (DSS) in clinical MRS of intracranial lesions and comparison to conventional MRS analysis and MRI.
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2015 (English)In: Neuroradiology, ISSN 0028-3940, E-ISSN 1432-1920, Vol. 57, no Suppl1, p. 67-68Article in journal (Refereed) Published
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:uu:diva-264585 (URN)
Conference
38th Annual Meeting of European Society of Neuroradiology, Neapel, Italy.
Available from: 2015-10-15 Created: 2015-10-15 Last updated: 2017-12-01
Finnsson, J., Sundblom, J., Dahl, N., Melberg, A. & Raininko, R. (2015). LMNB1-related autosomal-dominant leukodystrophy: Clinical and radiological course. Annals of Neurology, 78(3), 412-25
Open this publication in new window or tab >>LMNB1-related autosomal-dominant leukodystrophy: Clinical and radiological course
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2015 (English)In: Annals of Neurology, ISSN 0364-5134, E-ISSN 1531-8249, Vol. 78, no 3, p. 412-25Article in journal (Refereed) Published
Abstract [en]

OBJECTIVE: Duplication of the LMNB1 gene encoding lamin B1 causes adult-onset autosomal-dominant leukodystrophy (ADLD) starting with autonomic symptoms, which are followed by pyramidal signs and ataxia. Magnetic resonance imaging (MRI) of the brain reveals characteristic findings. This is the first longitudinal study on this disease. Our objective is to describe the natural clinical and radiological course of LMNB1-related ADLD.

METHODS: Twenty-three subjects in two families with LMNB1 duplications were studied over two decades with clinical assessment and MRI of the brain and spinal cord. They were 29 to 70 years old at their first MRI. Repeated MRIs were performed in 14 subjects over a time period of up to 17 years.

RESULTS: Pathological MRI findings were found in the brain and spinal cord in all examinations (i.e., even preceding clinical symptoms). MRI changes and clinical symptoms progressed in a definite order. Autonomic dysfunction appeared in the fifth to sixth decade, preceding or together with gait and coordination difficulties. Motor signs developed ascending from spastic paraplegia to tetraplegia and pseudobulbar palsy in the seventh decade. There were clinical, radiological, and neurophysiological signs of myelopathy. Survival lasted more than two decades after clinical onset.

INTERPRETATION: LMNB1-related ADLD is a slowly progressive neurological disease. MRI abnormalities of the brain and spinal cord can precede clinical symptoms by more than a decade and are extensive in all symptomatic patients. Spinal cord involvement is a likely contributing factor to early autonomic symptoms and spastic paraplegia. Ann Neurol 2015;78:412-425.

National Category
Neurosciences
Identifiers
urn:nbn:se:uu:diva-261207 (URN)10.1002/ana.24452 (DOI)000360218800008 ()26053668 (PubMedID)
Note

Atle Melberg och Raili Raininko delar sistaförfattarskapet.

Available from: 2015-08-31 Created: 2015-08-31 Last updated: 2018-01-11Bibliographically approved
Jameel, M., Klar, J., Tariq, M., Moawia, A., Altaf Malik, N., Seema Waseem, S., . . . Dahl, N. (2014). A novel AP4M1 mutation in autosomal recessive cerebral palsy syndrome and clinical expansion of AP-4 deficiency. BMC Medical Genetics, 15, 133
Open this publication in new window or tab >>A novel AP4M1 mutation in autosomal recessive cerebral palsy syndrome and clinical expansion of AP-4 deficiency
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2014 (English)In: BMC Medical Genetics, ISSN 1471-2350, E-ISSN 1471-2350, Vol. 15, p. 133-Article in journal (Refereed) Published
Abstract [en]

BACKGROUND:

Cerebral palsy (CP) is a heterogeneous neurodevelopmental disorder associated with intellectual disability in one-third of cases. Recent findings support Mendelian inheritance in subgroups of patients with the disease. The purpose of this study was to identify a novel genetic cause of paraplegic CP with intellectual disability in a consanguineous Pakistani family.

METHODS:

We performed whole-exome sequencing (WES) in two brothers with CP and intellectual disability. Analysis of AP4M1 mRNA was performed using quantitative real-time PCR on total RNA from cultured fibroblasts. The brothers were investigated clinically and by MRI.

RESULTS:

We identified a novel homozygous AP4M1 mutation c.194_195delAT, p.Y65Ffs*50 in the affected brothers. Quantitative RT-PCR analysis showed markedly reduced AP4M1 mRNA levels suggesting partial non-sense mediated mRNA decay. Several clinical and MRI features were consistent with AP-4 complex deficiency. However, in contrast to previously reported cases with AP4M1 mutations our patients show an aggressive behavior and a relatively late onset of disease.

CONCLUSION:

This study shows an AP4M1 mutation associated with aggressive behavior in addition to mild dysmorphic features, intellectual disability, spastic paraparesis and reduced head circumference. Our findings expand the clinical spectrum associated with AP-4 complex deficiency and the study illustrates the importance of MRI and WES in the diagnosis of patients with CP and intellectual disability.

National Category
Medical Genetics
Identifiers
urn:nbn:se:uu:diva-240694 (URN)10.1186/s12881-014-0133-2 (DOI)000348160200001 ()25496299 (PubMedID)
Available from: 2015-01-08 Created: 2015-01-08 Last updated: 2018-01-11Bibliographically approved
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