Search results for “Cerebral”

The Role of Cerebral Hypercarbia in the Induction of the Near-Death Experience

The near-death experience (NDE) is an altered state of consciousness which arises when a person is critically ill or injured and possibly clinically dead. It should not be conflated with other mental events such as the deathbed vision or the fear or anticipation of death. Many believe that the NDE represents a genuine paranormal phenomenon providing a glimpse of an otherworldly existence and proof of an afterlife. Those who are skeptical of such a survivalist or supernatural interpretation have long pointed out that the core components of the NDE can be readily simulated with a variety of states, conditions and agents. In this conception, the NDE is reduced to no more or less than an extraordinarily complex hallucination. Since its rediscovery in the 1970s, multiple, often ingenious, attempts have been made to account for the NDE in such naturalistic or neuroscientific terms. None has so far proven completely satisfactory. One of the oldest, least considered but still promising is the CO2 theory which argues that a hypercarbic brain is a necessary precursor for the induction of a NDE. Supportive evidence that CO2 does play a pivotal role in the generation of the NDE can be gathered from diverse sources. These include: 1. measurement of blood gases; 2. Meduna’s now abandoned CO2 therapy; 3. analysis of the very limited number of pathophysiological conditions underlying the NDE; 4. recent discoveries of the role of 5-HT neurons in the central respiratory system. A model is proposed in which CO2 molecules are considered to be functionally equivalent to those of the classical hallucinogens (LSD, mescaline, psilocybin, dimethyltryptamine). These agents can mimic the phenomenology of the NDE with remarkable fidelity. What is still missing from any such explanation is the long-sought transduction mechanism which converts physical events into mental ones. This is a generic problem which confronts all attempts to explain the neurogenesis of mystical, psychedelic or visionary activity.

Anti-DPPX-Encephalitis in A Patient with Cerebral Vasculitis and Connective Tissue Disease

Since the first description in 2013, 39 cases of anti-DPPX-encephalitis have been described. Main features of this autoimmune encephalitis characterized by antibodies against the potassium-channel-associated regulatory protein DPPX are gastrointestinal symptoms, cognitive dysfunction and signs of CNS hyperexcitability. While the majority of patients responds to immunotherapy relapses are frequent and often successfully treated with rituximab. Here we report another case of anti-DPPX-encephalitis presenting with the above mentioned triad. However, this is the first case of anti-DPPX-encephalitis in the context of a connective tissue disease combined with cerebral arteriopathy along with brain parenchymal lesions that we interpreted as a secondary, CTD-associated cerebral vasculitis. While the latter resolved under immunosuppressive treatment, comprising glucocorticosteroids, cyclophosphamide, rituximab and plasmapheresis, deterioration of the CTD and multiple infectious complications finally led to the patient's death. As histological evidence for cerebral vasculitis is lacking, other differential diagnoses for the observed cerebral arteriopathy, especially reversible cerebral vasoconstriction syndrome, have to be considered.

The Very Old in Randomized Surgical Intracerebral Hemorrhage Trails. Limitations Induced by Upper Age Limits.

Spontaneous intracerebral hemorrhage (ICH) is one of the leading causes of death worldwide. In randomized trials on surgical therapy inclusion of the very old was limited by the recruitment process. This study was performed to evaluate the age limits in published surgical trials on ICH, and to determine how upper age limits effect the inclusion of men and women in these and future trials on the basis of a large cohort of ICH patients in central Europe. The Hessian stroke registry, a state-wide prospective stroke databank, was used to analyze upper age limits and sex differences for patients with the diagnosis of ICH (ICD-10: I61.0 to I61.9) who were admitted between January 2010 and December 2012. Sex differences were calculated at different age cutoffs, and the proportions of potentially excluded sex-specific patients from surgical trials on ICH were calculated. Overall, 5184 patients with the diagnosis of spontaneous ICH were identified. A total of 2457 (47.4%) patients were female and 2727 (52.6%) patients were male. Mean age was 72.3 ± 13.6 years. Female patients were significantly older compared to male patients (74.9 ± 13.5 years vs. 69.9 ± 13.2 years; p<0.001). With an upper age limit of 70, 75, and 80 years, 3437 patients (66.3%), 2664 patients (51.4%), and 1765 patients (34.0%) were excluded, respectively. Upper age limits in surgical trials on ICH could lead to the exclusion of a significant portion of patients from studies. This should be noted when transferring conclusions from these trials into clinical practice.

Reversible Cerebral Lession and Irreversible Cerebral Necrosis After Cardiorespiratory Arrest: A Case Report

This case contrasts reversible cerebral lesions with areas of irreversible necrosis following cardiorespiratory arrest. The authors discuss imaging evolution, mechanisms of hypoxic–ischemic injury, and implications for prognostication and rehabilitation.

Multiple Cerebral, Calcified and Infected Hydatid Cysts Case Report and Literature Review

Calcified and Infected Hydatid Cysts Case Report and Literature Review

RETRACTED: In-Stent Thrombosis in the Middle Cerebral Artery (MCA): A Case Report

This article has been retracted on November 20, 2015. VIEW THE RETRACTION NOTICE (https://doi.org/10.14302/issn.2470-5020.jnrt-25-5846) In-stent thrombosis (IST) is a complication of angioplasty and stenting, especially in the vessels with smaller diameter. We present a case of subacute IST after stenting treatment of an isolated higher stenosis of the right middle cerebral artery (MCA). Analysis of clinical features and emergent brain image helped to indicate the pathophysiological mechanism underlining the symptoms of this patient. Emergent Transcranial Doppler (TCD) helped to evaluate the compensatory collateral circulation and provided good supporting evidence in deducing the mechanism of IST. Slightly larger size of the implanted stent that caused dissection or vascular endothelium injury was presumed in this patient. Persistent evidence of inflammatory factors might also contribute to IST in this patient.

Retraction Note: In-Stent Thrombosis in the Middle Cerebral Artery (MCA): A Case Report

RETRACTED: A Microglia Initiated Target Therapy in Neuroinflammation for Alzheimer’s Patients

This article has been retracted on 20 March 2025. VIEW THE RETRACTION NOTICE (https://doi.org/10.14302/issn.2998-4211.jalr-25-5855) The research is focused on neuroinflammation a normal physiological process which is known to be associated with neurodegenerative diseases could be the potential targeted therapy via the microglia cells, it starts with defining Alzheimer’s; a neurodegenerative disease which causes deposition of Aβ (amyloid beta) protein in the cerebral cortex as well as NFT (neurofibrillary tangles) in the hippocampus and basal ganglia. The paper then describes process of neuroinflammation, microglia’s role, apolipoprotein E4 gene in relation to Alzheimer’s, which leads to different stem cell research and how pruning microglia as well as targeting microglia receptors in the brain is being used in current research trials, we included multiple meta-analysis showing microglia receptors being targeted currently by emerging drugs like propofol, antibodies CSF1R inhibitor etc, which are currently under trial phase, the research ends with concluding potential diagnostic markers like sirt1 considered to be an anti-aging protein which can be used as therapeutic interventions and Lps effect on Sirt 1. A Microglia initiated target therapy in Neuroinflammation for Alzheimer’s Patients.

Chemotherapy after whole-brain radiotherapy: a prognostic factor for metastatic breast cancer

Background and Aim Breast cancer is the second most common cause of brain metastases after lung cancer. However, the incidence of cerebral metastases from breast cancer has increased during the last years. The purpose of this study is to determine the prognostic value of chemotherapy after whole-brain radiotherapy for patients with brain metastases from breast cancer. Methods We analyzed retrospectively 63 records of patients diagnosed with brain metastases from breast cancer and treated in the radiotherapy department at the Salah Azaiz Institute of oncology over a 5-year period between 2007 and 2011. All patients received whole-brain radiotherapy. Only 4 patients had surgical resection of the metastases before radiotherapy and 36.5% of patients received systemic treatment after irradiation. Results Overall survival was 19% at 1-year and median survival was 4,5 months. Univariate analysis indicated that systemic treatment after irradiation was correlated significantly with longer survival. (p=0,046). Conclusion Determining prognostic factors might help optimize individual treatment for metastatic breast cancer. The results of our study suggest that chemotherapy is more effective on brain metastases after irradiation. This can be explained by the fragilization of the blood-brain barrier by radiation and subsequently a better passage of cytotoxic agents.

Post-Covid-19 Acute Disseminated Encephalomyelitis (ADEM) in a 27-year-old girl: Case Report

Acute disseminated encephalomyelitis (ADEM) is a monophasic, multifocal, demyelinating, autoimmune disease that affects the central nervous system (CNS). It usually occurs after a systemic infection, usually viral, including certain coronavirus infections. A 27-year-old girl presented with complaints of left interscapular pain, paresthesias and weakness in the ipsilateral upper limb. These symptoms followed paresthesias on the fingertips of her right hand the day before her admission. she was treated two weeks earlier for pneumonia with COVID-19. Her clinical pattern resulted in a moderate weakness of the left limbs associated with tactil and algic hypoesthesia in the lower left limb ascending until the C4 level in the left side. Magnetic resonance imaging (MRI) of the brain and spinal cord showed diffuse spontaneous hypersignals on fluid-attenuated inversion recovery (FLAIR) images at the cerebral level and on T2-weighted images at the spinal level. These imaging lesions coupled with the medical history of a recent COVID-19 infection led to the diagnosis of acute disseminated encephalomyelitis (ADEM) post covid-19. The clinical condition improved rapidly with intravenous (IV) corticosteroid therapy and IV immunoglobulin combined with physiotherapy. ADEM is a demyelinating autoimmune disease which is increasingly reported during this current corona virus pandemic.

Reversible Posterior Encephalopathy Syndrome and Related Factors: Clinical Cases Study

Background Reversible posterior encephalopathy syndrome (RPE) is a clinical and radiological entity characterized by the acute or subacute fitting of symptoms covering headache, vomiting, visual disturbances, seizures and impairment of consciousness. The pathophysiology of RPE syndrome is poorly described. RPE syndrome is characterized by a reversible cerebral edema of often posterior topography in magnetic resonance imagery (MRI). Cases Presentation We consider RPE syndrome four cases under various conditions that are known as airplane flight, hypertension, non-steroidal anti-inflammatory medication, pregnancy and oldness with several pathologies. The RPE was described with several symptoms like headaches, vomiting, focal motor deficit, paresthesia, seizures, disorders of consciousness and photophobia. The imagery findings were varying from cortical hypersignals in Flair sequences to edema of both cortex and sub cortex. The outcome was good with a complete regression of symptoms and imagery lesions. Conclusion The pathophysiological mechanism of RPE syndrome remains unknown. High blood pressure, renal failure and drugs (anti-depressants, NSAIDs, immunosuppressants) are the most etiological factors. The diagnosis is based on clinical arguments and brain MRI. The main location is posterior. The clinical outcome was good with all the patients in our study, no recurrence was noted.

“Prevention of Death Anxiety by Familiarity with the Concept of Death”

Objectives Death is the only definitive phenomenon in life, and everyone is sure that it will happen in the future. Based on the philosophical perspective, the concept of death differs in different cultures. The purpose of this study was “explaining the difference between the concept of death from the perspective of theology and empirical science”. Methods In this qualitative evolutionary study, a targeted review was conducted to answer the question “what is the difference between the concept of death from the perspective of theology and empirical science?” Articles published between 1990 and 2018 were extracted from the PubMed, science direct, google scholar, SID, and Cochrane databases. At the same time, Islamic religious evidence (Quran and Hadiths) was investigated for understanding the concept of the death in Islam. The “Shia Seminary” research methodology was used to avoid interpretations of the Quran verses and to ensure the authenticity of the Hadiths. Findings Empirical sciences consider death as a biological phenomenon, which results from irreversible damage to cerebral hemispheres and brain stem (brain death) that causes grief process, fear, anxiety, and sadness. From the perspective of Islam, death is an existential phenomenon, the transfer of the soul from one world to another. Death is the complete reception of the soul from the body by the angels and the beginning of another life, in the "world of grief. Conclusion Given that in Islam, death does not mean destruction. It is imperative that the spiritual counselors teach the patient and the family about the life after death and the blessings of paradise. In pastoral care at the end of life, reducing patients’ anxiety and fear of death, with hope in God's mercy is necessary.

Brain Hemodynamics and Cerebrovascular Reactivity in Patients with Tension-Type Headache

Introduction: Tension-type headache (TTH) is very common, with a lifetime prevalence in the general population ranging in different studies between 30% and 78%. TTH, divided into episodic and chronic types, introduced in the manual "International Classification of Headache Disorders"(ICHD-I), is of practical importance. Infrequent episodic headaches (no more than once a month) may not require drug therapy, but, on the contrary, frequent forms may require expensive treatment. Objective: To study the state of cerebral hemodynamics and cerebrovascular reactivity in patients with Tension-type headache and evaluate the efficacy of treatment with Phenibite using Doppler ultrasound. Materials and Methods: A retrospective analysis of the results of ultrasound dopplerography of the anterior, middle and posterior cerebral arteries (ACA, MCA and PCA), Vertebral and Basal (VA, BA) arteries was performed in 188 patients with TTH. Among them are infrequent episodic TTH - 68 (36,2%) patients, frequent episodic TTH - 64 (34,0%) patients, chronic TTH - 56 (29,8%) patients. The age of the subjects was 18-45 years, among them 85 (45.2%) men and 103 (54.8%) women. The maximum systolic velocity (Vs), the end diastolic velocity (Vd), the resistance and pulsativity indexes (RI, PI) in all vessels were determined. Patients were given consent to participate in the study. Results: Infrequent episodic (IFE) TTH were recorded in 86.4% of cases, frequent episodic (FE) — in 88.9%, and chronic (Ch) TTH — in 81.6% of cases. Bilateral TTH was noted in 39.2%, frontal localization - in 35.6%, in the occipital region - in 25–7% of cases. The asymmetry of the maximum systolic blood flow velocity (Vs) in the paired arteries within 20-30% was considered a violation of cerebral hemodynamics, which was detected in 38.7% of patients. An increase in Vs was noted in all cerebral vessels, especially in patients with FE TTH and chronic Ch TTH compared with the control group. In patients with IFE TTH the average value of RcFMt was 1.24±0.03, in patients with FE TTH - 1.25±0.02, in patients with Ch TTH - 1.27±0.03. In patients with TTH, hyper-responsiveness to hypercapnic test was detected: RcCO2 was 1.43±0.05 in the group with FE TTH; 1.39±0.07 in the group of Ch TTH and 1.37±0.04 in the group of IFE TTH, which indicates a tendency for the tension of the vasodilator regulation mechanism even in clinically insignificant forms of TTH. In the study of reactivity to the O2-test, a hyporeactive response was observed in the groups with FE TTH and Ch TTH (0.38±0.04 and 0.35±0.05, respectively. The treatment with Phenibut carried out in a step-by-step manner - during the first week the drug was applied at a dose of 250 mg 2 times a day, over the next 6 weeks the dose increased to 500 mg 2 times a day, then the dose was reduced back to 250 mg 2 times a day. Among patients with FE TTH, the frequency of headache decreased from 5.7±2.3 to 3.6±2.1 days/month, and in patients with Ch TTH - from 22.8±1.7 to 17.7±1,3 days/month (P<0,05). Influence of the drug was manifested at the initially increased RcFMt and RcCO2. A decrease in initially elevated RcCO2 was noted in all (FE TTH, ChTTH, IFETTH) clinical groups. However, this decrease was not statistically significant. Conclusion: In patients with TTH, an increase in the Vs is more often recorded, their asymmetry in the middle cerebral artery. Hyperreactivity on CO2-load is typical for patients with chronic TTH, and reflects the mobilization of metabolic regulation of cerebral blood flow. Conducting FMt was the most informative method for detecting autoregulatory disorders mainly in patients with IFE TTH. FE TTH in patients is characterized by the presence of a hyperactive reaction to hypercapnic and orthostatic tests, probably due to mobilization of humoral-metabolic and neurogenic links of regulation. In the group of patients with chronic TTH prevails hyporeactivity for hyperventilation test, reflecting the depletion of vasoconstriction reserve. The use of Phenibut(Noophen® (JSC Olainfarm Latvia in the treatment of TTH is accompanied by a decrease in the frequency of pain, and of pericranial muscle tone, most pronounced in patients with FE TTH. It's effectiveness is evident in the normalization of the coefficients of cerebrovascular reactivity in a patients with chronic TTH. The minimal statistical significance was observed on the dynamics of blood flow only in the VA.

The Pineal Hypothesis for Drug Dependence

The pineal gland constitutes a major neuroendocrine organ in the brain. By mean of its neurohormone melatonin it transduces exogenous signals such as circadian and seasonal variations of light and temperature into proper hormonal changes which adjust and adapt internal endocrine functions. Alteration of circadian rhythms has been associated with affective disorders, psychosomatic diseases and cancer. It has been observed that light deprivation, which stimulates (the enzymes responsible for) melatonin production in the pineal, enhances the animal's ethanol preference. Similarly, administration of the pineal hormone to rats maintained under normal conditions of constant photoperiod also induced ethanol drinking. Our hypothesis is that in normal conditions melatonin might be acting as a cerebral "pacemaker", sensitive to endogenous as well as exogenous stimuli in the attempt to maintain an equilibrate circadian interaction between the cerebral activities of endogenous aminergic and opiates systems. Abnormal states (i.e. drug abuse) could result in altered pineal activity, then in rhythmically altered functions of cerebral opiates and/or monoamine neurotransmitters. This may led to the development of a “reward - urge for drug rhythm” resulting in craving, ending in addiction.

Microanatomy of Thalamic Radiations

Background Thalamic radiations also known as thalamocortical pathways are reciprocal myelinated nerve fibers, arranged in a fanning pattern, grouped into tracts or fasciculi; and connecting the thalamus to the cerebral cortex. Detailed in vitro study of these tracts is seldom reported in the literature. Objective We sought to describe the microanatomy of thalamic radiations by means of the fiber-dissection technique to discuss challenges in dissection techniques and anatomic nomenclature, and follow through with a literature review. Methods Twenty formalin-fixed normal human hemispheres were dissected according to Klingler’s fiber-dissection technique under operative microscope. Results Thalamic radiations are reciprocal myelinated nerve fibers connecting the thalamus to the cerebral cortex and are referred to as corticothalamic and thalamocortical tracts. They are the most medial fibers of the internal capsule and consist of anterior (thalamofrontal), superior (thalamo-fronto-parietal or thalamoparietal), posterior (thalamooccipital) and inferior (thalamotemporal) thalamic fasciculi. Conclusion From the cerebral cortex, thalamic radiation fibers fan out into the thalamus and are the most medial fibers of the internal capsule. There is a great deal of controversy surrounding the distinction between anterior and superior thalamic radiations, sub-ependymal stratum and the fronto-occipital fasciculus.

Severe Ischemic Stroke due to Progression of Cervical Carotid Artery Dissection

Spontaneous dissection of the cervical segment of the internal carotid artery (CS-ICA) is uncommon but not rare. A 43-year-old man suddenly developed complete right hemiparesis with motor aphasia. 3 weeks after the initial symptom onset. Magnetic resonance imaging showed enlargement of an intramural hematoma at the cervical carotid artery; it severely compressed and completely occluded the arterial lumen. Diffuse ischemia was observed in the area of the left middle cerebral artery (MCA) immediately after onset and he underwent emergency left superficial temporal artery-MCA double bypass within 6 hours. There was no fatal deterioration and his neurological deficit was resolved. We discuss our treatment of spontaneous dissection of the CS-ICA to prevent ischemic damage.

Regulation of Expression of Reactive Oxygen Intermediates During Plasmodium Infection to Reduce Immunopathology Provides a Possible Antioxidant Adjuvant to Enhance Anti-Malarial Drug Therapy

Malaria is a mosquito-transmitted infectious disease caused by intracellular protozoan parasites of the genus Plasmodium. In the absence of prompt and appropriate treatment contraction of primary infection by a human being often represents a medical emergency since it may progress rapidly to life-threatening complications. Exposure to parasites activates the immune system resulting in, among other effects, the release of reactive oxygen intermediates (ROI). This has the potential to induce oxidative damage, thereby causing cellular destruction, and hence to have a severe effect on vital organs of the body. Overexpression of ROI leads to immunosuppression and is a causal factor in the development of malaria-related disease symptoms. However, the body possesses various defence mechanisms, notably including the production of antioxidants, which are capable of reducing the cellular effects of ROI. Antioxidants are either sourced exogenously from the diet or synthesized through different intracellular mechanisms. Antioxidants that include glutathione peroxidase, catalase, EDTA and vitamin C suppress the initial production of ROI. Others such as uric acid, superoxide dismutase and vitamin E may also inhibit potentially damaging products of ROI metabolism. Current anti-malarial drugs often have damaging side-effects, as exemplified by memory impairment following treatment for cerebral malaria. Recent studies have explored the potential use of antioxidants alone or in combination with anti-malarials as a therapeutic means to negate Plasmodium-induced oxidative stress and its associated metabolic complications. It is indicated that when utilized in an adjuvant capacity antioxidants of natural and synthetic origin may improve anti-malarial therapy by causing less damage to the host during malaria infection.

Neurovascular Reactivity after Repeated Attacks in Patients with Multiple Sclerosis

Objectives Increased neurovascular (NV) reactivity has been shown in patients with relapsing-remitting multiple sclerosis (RRMS) during the acute exacerbation period. However, the NV reactivity after several attacks is not known. We, therefore, have investigated the patients by transcranial Doppler (TCD) using simple visual stimulation after the repeated attack periods. Patients and Methods Thirty patients (22 females and eight males, mean age 40 years) with RRMS were examined at least two times. The average TCD examination interval was 26.7 months (range 4-120 months). Mean attack number was 3.8 (range 2-8 times), average disease duration was 57 months (range 4-124 months), and average Expanded Disability Status Scale (EDSS) value was 2.5 (range 1-5.5). We performed transcranial Doppler recordings from the P2-segments of both posterior cerebral arteries simultaneously during simple visual stimulation. The NV reactivity was defined as a relative increase of the blood flow velocities during visual stimulation. Results The NV reactivity to simple visual stimulation was significantly lower in the second test on both sides (31.5±9.2% and 29.2±7.2%; right and left side, respectively) from those of the first test (38.3±11.9% and 36.0±11.9%; right and left side, respectively) (p<0.001). Conclusion The present study is the first study examining neurovascular reactivity in patients with RRMS during repeated attacks using the transcranial Doppler to our best knowledge. Our results suggest patients with RRMS after repeated exacerbation periods have less reactive neurovascular units in the occipital cortex. The possible explanation might be the repeated demyelination, and insufficient remyelination with longer disease duration may lead glial dysfunction resulting neurovascular unit impairment. If so, functional TCD may be useful for the determining of the disease progression. However, the exact cut-off point is not known.

Evaluation of a Stroke Protocol Using Computed Tomography Angiography for the Evaluation of Acute Ischemic Stroke Patients

Objectives: Computed tomography angiography (CTA) provides early assessment of cerebral vasculature in ED patients presenting with Acute Ischemic Stroke (AIS). Prior studies using 4 row detector CT scanners have suggested that results may be used to determine who receives thrombolytics (tPA). We sought to evaluate the rate of normal CTA and the use of tPA in AIS patients with and without blockages using modern CT technology. Patients and Methods: We conducted a retrospective cohort study of all code stroke patients presenting to our ED over a 3 year period. Inclusion criteria included an ED and neurology diagnosis of AIS with a CTA performed at presentation. All patients had a NIHSS score recorded at presentation and underwent imaging using a 64 row detector scanner with 50cc of non-ionic contrast. Demographic, imaging, and clinical data were collected. Modified Rankin Scores (mRS) were assigned at hospital discharge. Good clinical outcome was defined as a mRS of 0-2. Data are reported as frequencies and medians with interquartile ranges (IQR) as appropriate. Rates of tPA use were evaluated using χ2 testing. Rates of good outcomes were evaluated using odds ratios. Results: A total of 205 subjects met inclusion for analysis of which 103 (50%) were male and 109 (54%) had no blockage on CTA. The median NIHSS score and mortality rates were 14 (IQR 8-19), 14 (14%) with CTA blockage, and 4 (IQR 2-7), 2 (2%) for those without. Of those AIS with a blockage on CTA 46 (48%) were treated with tPA including 29 who were treated with intra-arterial therapy as well while only 13 (13%) of patients without a blockage were treated with tPA. Post tPA bleeding occurred in 12 (13%) patients with blockage on CTA and in 0 patients without blockage. Use of tPA was significantly more frequent in patients with a blockage on CTA, P <0.001. Conclusion: More than half of our AIS patients presenting through our ED have no blockage on CTA. Inter-rater reliability among neuroradiologists evaluating for large vessel occlusion appears to be very good. Patients with AIS and no blockage on CTA have less severe strokes and are less likely to receive tPA. Given the new guidelines recommending endovascular treatment for AIS we expect more emergency departments to begin performing CTA.

Surgical Managment of Intracranial Invasive Aspergillosis in Immunocompetent Patients: Results from 3 Case Reports

Cerebral aspergillosis is a severe disease most commonly suspected in immunodeficient patients. The objective of this study is to determine the role of surgery in management of intracranial aspergillosis. We report three cases of immunocompetent patients presenting: posteriror fossa aspergillosis, sphenoidal extended to sellar region aspergillosis and post operative aspergillosis without extracerebral involvement. Microbiology and histological examination were carried out to provide the diagnosis. The patients underwent surgical procedure associated with medical treatment or not. In one case, surgical treatment was efficient. The outcome was good in two cases. Conclusion: Rapid diagnosis of invasive aspergillosis applying radiological and surgical procedures and immediate ignition of antifungal can be life saving.

Outcome in Patients with Spontaneous Primary Intracranial Hemorrhage who underwent Craniotomy Affiliation

Background: Spontaneous primary intracranial hemorrhage or known as intracerebral hypertensive hemorrhage consist of 15 to 20% of all stroke, is one of the major health problems among healthy and productive workforce in any countries. Methods: A retrospective study was conducted in a dedicated Neurosurgical Centre at the Hospital Sungai Buloh, Malaysia. The study was conducted for admission within a year period, in the year 2013 with 6 months follow-up. A total of 35 patients were studied. Results: The mean age was 52.8 years old (31-77 years old). A total of 29 patients (82.9%) were presented with basal ganglia hemorrhage, 4 with cerebral lobar hemorrhage (11.4%) and 2 with cerebellar hemorrhage (5.7%). The surgical mortality rate was 40%. For the 6 months follow-up, 31.4% patients improved to Glasgow Outcome score (GOS) of 4, while 22.9% and 5.7% patients improved to only GOS of 3 and 2 respectively. There were several factors identified in the study to be important predictors of survival. There were statistically significance of higher mortality rate among patients with pre-operative GCS of 5 and below (p=0.015), pre-operative CT scan brain showing acute hydrocephalus (p=0.046) and residual post-operative hematoma above 5% of pre-operative clots volume (p=0.006). Other factors such as age, sex, size of pre-operative hematomas, presence of intraventricular hemorrhage, underlying medical illness were not statistically significant in predicting the surgical outcome of those patients. Conclusions: Outcome predictors such as pre-operative GCS and CT scan brain findings helps treating neurosurgeons to determine the prognosis of patients presented with spontaneous intracranial hemorrhage.

Evidence that N-acetylaspartylglutamate is the Astrocyte-Targeted Neurovascular Coupling Agent that Regulates Slow Tonic Control of Brain Blood Flow

N-acetylaspartylglutamate (NAAG) is the highest concentration dipeptide present in brain. It is found primarily in neurons but its function is unclear. NAAG is synthesized by neurons from N-acetylaspartate and glutamate (Glu), maintained at mM concentrations and is released non-synaptically to extracellular fluid (ECF). NAAG is a non-excitatory form of Glu, and is targeted to the metabotropic group II Glu receptor 3 (mGluR3) on the surface of astrocytes. After docking with the receptor, Glu is released by the action of NAAG peptidase. Previously, it was shown for the first time that an NAAG-peptidase inhibitor reduced global cerebral blood flow (CBF) in mouse brain but did not affect their physical performance. Recently, it has been demonstrated that there are two separate systems involved in neurovascular coupling by astrocytes, one is a rapid focal phasic response providing energy for stimulation-induced neuronal activity, and the other a slower global tonic response providing energy for ongoing metabolic activities. Many neurovascular coupling mechanisms are known that regulate phasic changes in CBF, but how the brain accomplishes tonic control is unknown. In this paper we bring together two separate lines of inquiry, the decades’ long search for the function of NAAG, and the more recent search for the mechanism of tonic neurovascular control. Herein, we present evidence that NAAG is the neurovascular coupling agent that regulates tonic changes in CBF via the astrocyte mGluR3-NAAG peptidase connection.