In Parkinson’s disease (PD), there is a reduction of neuromelanin (NM) in the substantia nigra (SN). Manual quantification of the NM volume in the SN is unpractical and time-consuming; therefore, we aimed to quantify NM in the SN with a novel semi-automatic segmentation method. Twenty patients with PD and twelve healthy subjects (HC) were included in this study. T1-weighted spectral pre-saturation with inversion recovery (SPIR) images were acquired on a 3T scanner. Manual and semi-automatic atlas-free local statistics signature-based segmentations measured the surface and volume of SN, respectively. Midbrain volume (MV) was calculated to normalize the data. Receiver operating characteristic (ROC) analysis was performed to determine the sensitivity and specificity of both methods. PD patients had significantly lower SN mean surface (37.7 ± 8.0 vs. 56.9 ± 6.6 mm²) and volume (235.1 ± 45.4 vs. 382.9 ± 100.5 mm³) than HC. After normalization with MV, the difference remained significant. For surface, sensitivity and specificity were 91.7 and 95 percent, respectively. For volume, sensitivity and specificity were 91.7 and 90 percent, respectively. Manual and semi-automatic segmentation methods of the SN reliably distinguished between PD patients and HC. ROC analysis shows the high sensitivity and specificity of both methods.

Surgery is an alternative treatment of drug-resistant epilepsy. Positive attitude of medical personnel towards epilepsy surgery is essential. This study assessed general knowledge of and attitude towards epilepsy surgery among medical students. The aim of this study was to assess general knowledge of and attitude towards epilepsy surgery among medical students. Questionnaire was distributed to medical students. Questionnaire consisted of two questions of general knowledge of drug-resistant epilepsy, questions of students’ attitude towards epilepsy surgery and questions of referral of patients. The Chi-square test was utilized. The terms “drug-resistant epilepsy” and “mesial temporal sclerosis” were known in 72.3 and 14.2 percent, respectively. Awareness and support of epilepsy surgery were recorded in 74.5 and 48.9 percent, respectively. A drug resistant patient would have been referred to a qualified centre in 19.4 percent. General knowledge and awareness of epilepsy surgery were better in higher levels of study (p < 0.001). Medical students have a positive attitude towards epilepsy surgery. Students are aware of drug resistance in epilepsy. Knowledge and awareness are better among students in higher levels, after neurology is introduced to the curriculum. We conclude that highlighting the importance of epilepsy surgery should be continued. Moreover, additional educational effort should be invested in expressing the importance of efficient referral of a patient to a qualified centre.

Background and Purpose: Hepatic encephalopathy (HE) is a neuropsychiatric syndrome associated with liver cirrhosis (LC) that often results in cognitive impairment. Minimal HE (mHE), a subtle form of the condition, significantly affects patients’ quality of life. Advanced imaging techniques, such as quantitative susceptibility mapping (QSM), provide new insights into the brain changes associated with HE. Materials and Methods: The study included 28 patients (17 with mHE and 11 without) with alcohol-induced LC and 25 healthy controls. MR imaging, including QSM, was utilized to assess microstructural tissue changes and iron deposition in the brain. Cognitive function was assessed through a neuropsychological test battery. QSM quantified magnetic susceptibility in deep gray matter, while enlarged perivascular spaces (EPVS) were evaluated using T2-weighted images. Statistical analyses, including non-parametric tests and linear regression, assessed differences in susceptibility and their correlation with cognitive performance and EPVS. Results: Significant differences in cognitive performance and brain susceptibility were observed between patients and controls. Patients exhibited lower susceptibility in the caudate nucleus with the accumbens (CNA); mHE patients, in particular, had a significant reduction in CNA susceptibility. Additionally, EPVS grade correlated positively with cognitive decline, suggesting that EPVS may play an essential role in the pathophysiology of mHE. Conclusions: This study demonstrates that QSM can detect subtle brain changes in LC patients, with decreased susceptibility in the CN (caudate nucleus) linked to cognitive impairment in mHE. The role of EPVS in HE warrants further investigation, as it may affect the efficacy of current diagnostic and therapeutic approaches. These findings highlight the potential of QSM to improve HE assessment.