Metronidazole-induced encephalopathy.

Metronidazole is a widely used antibacterial and antiprotozoal agent for a number of conditions. Whilst its more common gastrointestinal side effects are well known, neurotoxicity remains under-recognised. Both central and peripheral neurological side effects have been described. This report describes a case of radiologically confirmed metronidazole-induced cerebellar ataxia in a cirrhotic patient with a review of the literature. Awareness of this side effect is essential for prompt recognition as early drug withdrawal leads to resolution in the majority of cases.

Brain of the African wild dog. I. Anatomy, architecture, and volumetrics.

The African wild dog is endemic to sub-Saharan Africa and belongs to the family Canidae which includes domestic dogs and their closest relatives (i.e., wolves, coyotes, jackals, dingoes, and foxes). The African wild dog is known for its highly social behavior, co-ordinated pack predation, and striking vocal repertoire, but little is known about its brain and whether it differs in any significant way from that of other canids. We employed gross anatomical observation, magnetic resonance imaging, and classical neuroanatomical staining to provide a broad overview of the structure of the African wild dog brain. Our results reveal a mean brain mass of 154.08 g, with an encephalization quotient of 1.73, indicating that the African wild dog has a relatively large brain size. Analysis of the various structures that comprise their brains and their topological inter-relationships, as well as the areas and volumes of the corpus callosum, ventricular system, hippocampus, amygdala, cerebellum and the gyrification index, all reveal that the African wild dog brain is, in general, similar to that of other mammals, and very similar to that of other carnivorans. While at this level of analysis we do not find any striking specializations within the brain of the African wild dog, apart from a relatively large brain size, the observations made indicate that more detailed analyses of specific neural systems, particularly those involved in sensorimotor processing, sociality or cognition, may reveal features that are either unique to this species or shared among the Canidae to the exclusion of other Carnivora.

Emerging differences between Huntington's disease-like 2 and Huntington's disease: A comparison using MRI brain volumetry.

Huntington's Disease-Like 2 (HDL2), caused by a CTG/CAG expansion in JPH3 on chromosome 16q24, is the most common Huntington's Disease (HD) phenocopy in populations with African ancestry. Qualitatively, brain MRIs of HDL2 patients have been indistinguishable from HD. To determine brain regions most affected in HDL2 a cross-sectional study using MRI brain volumetry was undertaken to compare the brains of nine HDL2, 11 HD and nine age matched control participants. Participants were ascertained from the region in South Africa with the world's highest HDL2 incidence. The HDL2 and HD patient groups showed no significant differences with respect to mean age at MRI, disease duration, abnormal triplet repeat length, or age at disease onset. Overall, intracerebral volumes were smaller in both affected groups compared to the control group. Comparing the HDL2 and HD groups across multiple covariates, cortical and subcortical volumes were similar with the exception that the HDL2 thalamic volumes were smaller. Consistent with other similarities between the two diseases, these results indicate a pattern of neurodegeneration in HDL2 that is remarkably similar to HD. However smaller thalamic volumes in HDL2 raises intriguing questions into the pathogenesis of both disorders, and how these volumetric differences relate to their respective phenotypes.

Steatosis in South African women: How much and why?

BACKGROUND: Globally, steatosis is the commonest type of liver pathology and is closely associated with obesity and the metabolic syndrome. Obesity is common in urban African females but no data is available on hepatic fat content in this population group when compared to other ethnic groups. The aim of this study was therefore to compare hepatic fat content in woman from different ethnic groups in South Africa and to characterise the principle determinants of liver fat. MATERIALS AND METHODS: A convenience sample of 106 (48 Indian, 29 African and 29 Caucasian) female volunteers aged 20-60 years and having no history of cardiometabolic disorders were recruited. Hepatic fat was determined from CT scans using the liver-spleen attenuation ratio (LAR), which decreases with increasing levels of hepatic fat. Anthropometric and cardiometabolic parameters were measured with insulin resistance determined using the HOMA index and dysglycaemia defined as fasting glucose ≥5.60 mmol/L. RESULTS: The African subjects had significantly lower hepatic fat content (LAR as median [interquartile range]: 1.35 [1.28, 1.41]) than the Indian (1.22 [1.10, 1.35]; p<0.005) and Caucasian (1.27 [1.16, 1.33]; p<0.05) females even though they had significantly higher BMIs than both groups (p<0.0005 and p<0.05, respectively). Linear regression showed that: subcutaneous abdominal fat was a significant (unstandardised ß = 0.007; p = 0.03) negative, whilst insulin resistance (ß = -0.97; p = 0.01) and dysglycaemia (ß = -3.58; p = 0.01) were significant positive determinants of liver fat; higher hepatic fat levels in subjects with the metabolic syndrome were explained by insulin resistance and dysglycaemia. DISCUSSION: African ethnicity is associated with low liver fat content. Subcutaneous abdominal fat protects against steatosis, possibly by acting as a triglyceride reservoir. Insulin resistance and dysglycaemia lead to greater hepatic fat deposition and explain higher liver fat levels in subjects with the metabolic syndrome. These observations must be further investigated in longitudinal surveys.

The Brain of the Black (Diceros bicornis) and White (Ceratotherium simum) African Rhinoceroses: Morphology and Volumetrics from Magnetic Resonance Imaging.

The morphology and volumetrics of the understudied brains of two iconic large terrestrial African mammals: the black (Diceros bicornis) and white (Ceratotherium simum) rhinoceroses are described. The black rhinoceros is typically solitary whereas the white rhinoceros is social, and both are members of the Perissodactyl order. Here, we provide descriptions of the surface of the brain of each rhinoceros. For both species, we use magnetic resonance images (MRI) to develop a description of the internal anatomy of the rhinoceros brain and to calculate the volume of the amygdala, cerebellum, corpus callosum, hippocampus, and ventricular system as well as to determine the gyrencephalic index. The morphology of both black and white rhinoceros brains is very similar to each other, although certain minor differences, seemingly related to diet, were noted, and both brains evince the general anatomy of the mammalian brain. The rhinoceros brains display no obvious neuroanatomical specializations in comparison to other mammals previously studied. In addition, the volumetric analyses indicate that the size of the various regions of the rhinoceros brain measured, as well as the extent of gyrification, are what would be predicted for a mammal with their brain mass when compared allometrically to previously published data. We conclude that the brains of the black and white rhinoceros exhibit a typically mammalian organization at a superficial level, but histological studies may reveal specializations of interest in relation to rhinoceros behavior.

In contrast to many other mammals, cetaceans have relatively small hippocampi that appear to lack adult neurogenesis.

The hippocampus is essential for the formation and retrieval of memories and is a crucial neural structure sub-serving complex cognition. Adult hippocampal neurogenesis, the birth, migration and integration of new neurons, is thought to contribute to hippocampal circuit plasticity to augment function. We evaluated hippocampal volume in relation to brain volume in 375 mammal species and examined 71 mammal species for the presence of adult hippocampal neurogenesis using immunohistochemistry for doublecortin, an endogenous marker of immature neurons that can be used as a proxy marker for the presence of adult neurogenesis. We identified that the hippocampus in cetaceans (whales, dolphins and porpoises) is both absolutely and relatively small for their overall brain size, and found that the mammalian hippocampus scaled as an exponential function in relation to brain volume. In contrast, the amygdala was found to scale as a linear function of brain volume, but again, the relative size of the amygdala in cetaceans was small. The cetacean hippocampus lacks staining for doublecortin in the dentate gyrus and thus shows no clear signs of adult hippocampal neurogenesis. This lack of evidence of adult hippocampal neurogenesis, along with the small hippocampus, questions current assumptions regarding cognitive abilities associated with hippocampal function in the cetaceans. These anatomical features of the cetacean hippocampus may be related to the lack of postnatal sleep, causing a postnatal cessation of hippocampal neurogenesis.

Organization and chemical neuroanatomy of the African elephant (Loxodonta africana) hippocampus.

Elephants are thought to possess excellent long-term spatial-temporal and social memory, both memory types being at least in part hippocampus dependent. Although the hippocampus has been extensively studied in common laboratory mammalian species and humans, much less is known about comparative hippocampal neuroanatomy, and specifically that of the elephant. Moreover, the data available regarding hippocampal size of the elephant are inconsistent. The aim of the current study was to re-examine hippocampal size and provide a detailed neuroanatomical description of the hippocampus in the African elephant. In order to examine the hippocampal size the perfusion-fixed brains of three wild-caught adult male African elephants, aged 20-30 years, underwent MRI scanning. For the neuroanatomical description brain sections containing the hippocampus were stained for Nissl, myelin, calbindin, calretinin, parvalbumin and doublecortin. This study demonstrates that the elephant hippocampus is not unduly enlarged, nor specifically unusual in its internal morphology. The elephant hippocampus has a volume of 10.84 ± 0.33 cm³ and is slightly larger than the human hippocampus (10.23 cm(3)). Histological analysis revealed the typical trilaminated architecture of the dentate gyrus (DG) and the cornu ammonis (CA), although the molecular layer of the dentate gyrus appears to have supernumerary sublaminae compared to other mammals. The three main architectonic fields of the cornu ammonis (CA1, CA2, and CA3) could be clearly distinguished. Doublecortin immunostaining revealed the presence of adult neurogenesis in the elephant hippocampus. Thus, the elephant exhibits, for the most part, what might be considered a typically mammalian hippocampus in terms of both size and architecture.

Elephants have relatively the largest cerebellum size of mammals.

The current study used MR imaging to determine the volume of the cerebellum and its component parts in the brain of three adult male African elephants (Loxodonta africana) and compared this with published data from Asian elephants and other mammalian species including odontocete cetaceans, primates, chiropterans, insectivores, carnivores, and artiodactyls. The cerebellum of the adult elephant has a volume of ∼925 mL (average of both African and Asian species). Allometric analysis indicates that the elephant has the largest relative cerebellum size of all mammals studied to date. In addition, both odontocete cetaceans and microchiropterans appear to have large relative cerebellar sizes. The vermal and hemispheric components of the African elephant cerebellum are both large relative to other mammals of similar brain size, however, for odontocete cetaceans the vermal component is small and the hemispheric component is large. These volumetric observations are related to life-histories and anatomies of the species investigated. The current study provides context for one aspect of the elephant brain in the broader picture of mammalian brain evolution.

Quantitative analysis of neocortical gyrencephaly in African elephants (Loxodonta africana) and six species of cetaceans: comparison with other mammals.

This study provides quantitative data on the extent of gyrencephaly in the large-brained African elephant and several species of cetaceans (from smaller to larger brained) in comparison with other mammals. Across three mammalian orders (primates, carnivores, and artiodactyls), the species with the larger brains are more gyrencephalic with each order, exhibiting a specific negative allometry. The African elephant, with a 5-kg brain, has a gyrencephalic index (GI) of 3.89, which, though highly gyrencephalic, is not more so than would be predicted for a mammal with a 5-kg brain. The cetaceans had an average GI of 5.43, are the most gyrencephalic mammals studied to date, and are more gyrencephalic than one would predict based on comparison with other mammals. No relationship between brain mass and GI was evident in the cetaceans as seen in other mammals, with all cetaceans showing similar GIs irrespective of brain mass (range of GI 5.23-5.70, range of brain mass 577-5617 g). This is yet another parameter indicating cetaceans to be neuroanatomical outliers. Two species of pinnipeds studied had GIs that were well above those seen for terrestrial carnivores, and the aquatic manatee was close to lissencephalic. Thus, all three groups of marine mammals showed unusual extents of cortical gyrencephaly, indicating a morphological alteration of the telencephalon associated with the return to the marine environment. The analysis suggests that cortical thickness and neuronal density are important factors in determining the extent of gyrencephaly across mammalian species.

Volumetric analysis of the African elephant ventricular system.

This study used magnetic resonance imaging (MRI) to determine the volume of the ventricular system in the brain of three adult male African elephants (Loxodonta africana). The ventricular system of the elephant has a volume of ∼240 mL, an order of magnitude larger than that seen in the adult human. Despite this large size, allometric analysis indicates that the volume of the ventricles in the elephant is what one would expect for a mammal with an ∼5 kg brain. Interestingly, our comparison with other mammals revealed that primates appear to have small relative ventricular volumes, and that megachiropterans and microchiropterans follow different scaling rules when comparing ventricular volume to brain mass indicating separate phylogenetic histories. The current study provides context for one aspect of the elephant brain in the broader picture of mammalian brain evolution.

Visual acuity and heterogeneities of retinal ganglion cell densities and the tapetum lucidum of the African elephant (Loxodonta africana).

The eyes of three adult male African elephants were examined, the retinas were whole-mounted, stained and analyzed to determine visual acuity. A range of small to large ganglion cell types were observed across the retinas. We observed three regions of high ganglion cell density, one in the upper temporal quadrant, a visual or horizontal streak and a smaller region at the nasal end of the horizontal streak. The peak density of ganglion cells observed was 5,280/mm(2), and our calculations indicate that the elephant has a maximal visual acuity of between 13.16 and 14.37 cycles/degree. We observed a heterogeneous structure of a tapetum lucidum, the cells of which were found to be most strongly aggregated behind the temporal and nasal densities of retinal ganglion cells. The strength of the tapetum lucidum was weaker posterior to the density of ganglion cells forming the horizontal streak. The morphology of the elephant eye appears to be such that it reflects: (1) the importance of trunk-eye co-ordination for feeding; (2) the importance of 24-hour vigilance for either predators or conspecifics, and (3) the arrhythmic nature of the daily activity of this animal, being useful both diurnally and nocturnally.

Assessment of the medial head of the gastrocnemius muscle in functional compression of the popliteal artery.

OBJECTIVE: Nonfunctional popliteal entrapment is due to embryologic maldevelopment within the popliteal fossa. Functional entrapment occurs in the apparent absence of an anatomic abnormality. Gastrocnemius hypertrophy has been associated with the latter. Both forms of entrapment may cause arterial injury and lower limb ischemia. This study assessed the attachment of the medial head of the gastrocnemius muscle in healthy occluders and healthy nonoccluders. METHODS: Provocative tests were used to identify 58 nonoccluders and 16 occluders. Ten subjects from each group underwent magnetic resonance imaging evaluation of the popliteal fossa. The medial head of the gastrocnemius muscle attachment was assessed in the supracondylar, pericondylar, and intercondylar areas. RESULTS: In the occluder group, significantly more muscle was attached towards the femoral midline (supracondylar), around the lateral border of the medial condyle (pericondylar), and within the intercondylar fossa. CONCLUSION: The more extensive midline position of the medial head of the gastrocnemius in occluders is likely to be a normal embryological variation. Forceful contraction results in compression and occlusion of the adjacent popliteal artery. The clinical significance of these anatomic variations remains unclear. However, these new observations may provide insight for future analysis of the causes and natural history of functional compression and the potential progression to clinical entrapment.