RESUMEN
Keyhole aqueduct syndrome is a rare progressive neurodegenerative disorder describing a unique set of neuro-ophthalmologic, neuroimaging, and histopathological findings on autopsy. A midline mesencephalic cleft communicating with the cerebral aqueduct resembling syrinx is seen on imaging and histopathology. There are 9 cases published in the literature. We encountered a patient with vertical nystagmus, internuclear ophthalmoplegia, and progressive ataxia who has a midline cleft connecting the cerebral aqueduct with the interpeduncular cistern highlighting a distinguishing feature of this syndrome.
Asunto(s)
Acueducto del Mesencéfalo , Imagen por Resonancia Magnética , Humanos , Acueducto del Mesencéfalo/diagnóstico por imagen , Acueducto del Mesencéfalo/anomalías , Acueducto del Mesencéfalo/patología , Imagen por Resonancia Magnética/métodos , Síndrome , Diagnóstico Diferencial , Masculino , FemeninoRESUMEN
The goal of the Enhancing Neuroimaging Genetics through Meta-Analysis (ENIGMA) Stroke Recovery working group is to understand brain and behavior relationships using well-powered meta- and mega-analytic approaches. ENIGMA Stroke Recovery has data from over 2,100 stroke patients collected across 39 research studies and 10 countries around the world, comprising the largest multisite retrospective stroke data collaboration to date. This article outlines the efforts taken by the ENIGMA Stroke Recovery working group to develop neuroinformatics protocols and methods to manage multisite stroke brain magnetic resonance imaging, behavioral and demographics data. Specifically, the processes for scalable data intake and preprocessing, multisite data harmonization, and large-scale stroke lesion analysis are described, and challenges unique to this type of big data collaboration in stroke research are discussed. Finally, future directions and limitations, as well as recommendations for improved data harmonization through prospective data collection and data management, are provided.
Asunto(s)
Imagen por Resonancia Magnética , Neuroimagen , Accidente Cerebrovascular , Humanos , Estudios Multicéntricos como Asunto , Accidente Cerebrovascular/diagnóstico por imagen , Accidente Cerebrovascular/patología , Accidente Cerebrovascular/fisiopatología , Rehabilitación de Accidente CerebrovascularRESUMEN
BACKGROUND: The recent proliferation of electric standing scooters in major urban areas of the United States has been accompanied by injuries of varying severity and nature, representing a growing public health concern. OBJECTIVE: Our aim was to characterize imaging utilization patterns for injuries associated with electric scooter (e-scooter) use, including their initial emergency department (ED) management. METHODS: We conducted a retrospective review of the electronic medical record for all patients presenting to affiliated EDs for e-scooter-related injuries between July 2018 and April 2020. Demographics, date and time of presentation, imaging study type, resultant injury, and procedural details were recorded. RESULTS: Ninety-seven patients were included; mean age was 27.6 years. Of these, 55 patients (57%) had injuries identified on imaging and 40% of all imaging studies were positive. Most identified injuries (61%) were musculoskeletal, with a small number of neurological (2%) and genitourinary (1%) injuries. The highest prevalence of presentations occurred in August; most patients (72%) presented between 3 pm and 1 am and granular peaks were between 12 am and 1 am and 5 pm and 6 pm. CONCLUSIONS: Patients presenting with e-scooter injuries have a high likelihood of injury to the radial head, nasal bone, and malleoli. Emergency physicians should be especially vigilant for injuries in these areas at presentation. Visceral injuries are uncommon but may be severe enough to warrant surgery.
Asunto(s)
Traumatismos por Electricidad , Servicio de Urgencia en Hospital , Adulto , Diagnóstico por Imagen , Traumatismos por Electricidad/epidemiología , Traumatismos por Electricidad/etiología , Registros Electrónicos de Salud , Humanos , Estudios Retrospectivos , Estados UnidosRESUMEN
Status epilepticus (SE) is associated with high mortality and morbidity. Although SE is frequently seen in elderly patients, there is a lack of a cohesive report of outcome measures and associated factors within this population. Our aim was to systematically review studies reporting outcomes of SE among elderly patients and factors influencing these outcomes. A literature search was conducted in PubMed/MEDLINE, EMBASE, CINAHL Complete, and Cochrane Library from database conception to April 22, 2018. A total of 85 studies were included in this systematic review. The included studies show that mortality is higher in elderly patients than in adult patients. Lesional etiologies, higher number of comorbidities, NCSE, RSE, longer hospital and intensive care unit stays, and infection during hospitalization are associated with poor outcome. Future studies should consider measuring functional outcomes, comparative studies between elderly and adults and AED clinical trials specific for elderly with SE.
Asunto(s)
Anticonvulsivantes , Estado Epiléptico , Adulto , Anciano , Anticonvulsivantes/uso terapéutico , Comorbilidad , Humanos , Unidades de Cuidados Intensivos , Estudios Retrospectivos , Estado Epiléptico/diagnóstico , Estado Epiléptico/epidemiología , Estado Epiléptico/terapiaRESUMEN
Headaches are exceedingly common, but most individuals who seek medical attention with headache will not have a serious underlying etiology such as a brain tumor. Brain tumors are uncommon; however, many patients with brain tumors do suffer from headaches. Generally these headaches are accompanied by other neurologic signs and symptoms. A careful clinical assessment for red flags should be undertaken when considering further work-up with neuroimaging to exclude a serious underlying condition.
Asunto(s)
Neoplasias Encefálicas/complicaciones , Neoplasias Encefálicas/diagnóstico por imagen , Cefalea/etiología , Neuroimagen , Adulto , Niño , HumanosRESUMEN
BACKGROUND: Subdural empyema can present as a spinal subdural empyema (SSE) or a cranial subdural empyema (CSE). Although they differ somewhat in epidemiology, etiology, pathophysiology, and symptomatology and occur separately, they rarely manifest together. The aim of this article is to review the literature concerning the clinical presentation, clinical course, and treatment options for managing concurrently occurring SSE and CSE. METHODS: The literature in the Medline database was reviewed with key words including but not limited to subdural empyema, retroclival empyema, and Streptococcus mitis. No similar reports were found in the database involving infection with this type of microorganism in this anatomical region. RESULTS: Only 3 cases with concurrent CSE and SSE were found in the literature caused by various etiologic agents. Two of the patients recovered with no neurologic deficit, whereas one fatality was reported. One new illustrative case caused by Streptococcus mitis is also presented. CONCLUSIONS: CSE and SSE are neurosurgical emergencies, often requiring prompt surgical evacuation. Although very rare, Streptococcus mitis can cause spinal subdural empyema or retroclival abscesses. Natural history of this disease is grave without treatment. Delays in diagnosis and treatment are directly related to mortality and severe morbidity in patients with intracranial and spinal subdural empyema. Prompt recognition and treatment are essential to preclude severe neurologic disabilities or in rare cases a fatal outcome. A treatment paradigm for cranio-spinal empyema is proposed.
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Absceso/complicaciones , Empiema Subdural/complicaciones , Empiema Subdural/terapia , Enfermedades de la Médula Espinal/complicaciones , Enfermedades de la Médula Espinal/terapia , Absceso/diagnóstico por imagen , Absceso/terapia , Antibacterianos/uso terapéutico , Empiema Subdural/diagnóstico por imagen , Femenino , Humanos , MEDLINE/estadística & datos numéricos , Imagen por Resonancia Magnética , Persona de Mediana Edad , Enfermedades de la Médula Espinal/diagnóstico por imagenRESUMEN
INTRODUCTION: Melatonin, the secretory product of the pineal gland, has potent antioxidant properties. The aim of this study was to compare the effects of low-dose (10 mg/kg) vs high-dose (50 mg/kg) melatonin on early lipid peroxidation levels and ultrastructural changes in experimental blunt sciatic nerve injury (SNI). We believe this to be the first study to assess the dose-dependent neuroprotective effects of melatonin after a blunt peripheral nerve injury. MATERIALS AND METHODS: Rats were randomly allocated into 5 groups of 10 animals each. The SNI only rats underwent a nerve injury procedure. The SNI plus vehicle group received SNI and intraperitoneal injection of vehicle (diluted ethanol) as a placebo. The SNI plus low-dose or high-dose melatonin groups received intraperitoneal melatonin at doses of 10 mg/kg or 50 mg/kg, respectively. Controls had no operation, melatonin or vehicle injection. SNI was induced by clamping the sciatic nerve at the upper border of the quadratus femoris for 2 min. RESULTS: Sciatic nerve samples were harvested 6 h after nerve injury and processed for biochemical and ultrastructural analysis. Trauma increased the lipid peroxidation of the sciatic nerve by 3.6-fold (153.85 +/- 18.73 in SNI only vs 41.73 +/- 2.23 in control rats, P < 0.01). Low (P = 0.02) and high (P < 0.01) doses of melatonin attenuated the nerve lipid peroxidation by 25% and 57.25%, respectively (65.76 +/- 2.47 in high-dose vs 115.08 +/- 7.03 in low-dose melatonin groups). DISCUSSION: Although low-dose melatonin reduced trauma-induced myelin breakdown and axonal changes in the sciatic nerve, high-dose melatonin almost entirely neutralized any ultrastructural changes. CONCLUSION: Our results suggest that melatonin, especially at a dose of 50 mg/kg, has a potent neuroprotective effect and can preserve peripheral neural fibers from lipid peroxidative damage after blunt trauma. With further investigations, we hope that these data may prove useful to clinicians who treat patients with nerve injuries.
Asunto(s)
Peroxidación de Lípido/efectos de los fármacos , Melatonina/uso terapéutico , Fármacos Neuroprotectores/uso terapéutico , Nervio Ciático/metabolismo , Neuropatía Ciática/tratamiento farmacológico , Análisis de Varianza , Animales , Antioxidantes/administración & dosificación , Antioxidantes/uso terapéutico , Relación Dosis-Respuesta a Droga , Inyecciones Intraperitoneales , Masculino , Melatonina/administración & dosificación , Microscopía Electrónica/métodos , Fármacos Neuroprotectores/administración & dosificación , Ratas , Ratas Wistar , Nervio Ciático/lesiones , Nervio Ciático/ultraestructura , Neuropatía Ciática/metabolismo , Neuropatía Ciática/patología , Espectrofotometría/métodosRESUMEN
The authors present a rare case of C-6 vertebral involvement in a 12-year-old boy with histiocytosis X. The patient presented with limitation in movements of neck and upper extremities. Computed tomography (CT) and magnetic resonance (MRI) imaging were used in the preoperative workup. Surgery was performed via an anterior cervical approach along with stabilization using a fibula strut graft and plate fixation. Pathological assessment showed infiltration of Langerhans cells accompanied by a mixture of many eosinophils, giant cells, neutrophils and foamy cells. The patient went on to make a full recovery with complete resolution of his motor weakness. In an extensive review of the literature there are very few cases of cervical histiocytosis X reported. In addition, surgical management of this type of lesion has rarely been discussed.
Asunto(s)
Vértebras Cervicales/patología , Histiocitosis de Células de Langerhans/patología , Histiocitosis de Células de Langerhans/fisiopatología , Enfermedades de la Columna Vertebral/patología , Vértebras Cervicales/cirugía , Niño , Histiocitosis de Células de Langerhans/cirugía , Humanos , Masculino , Debilidad Muscular/etiología , Procedimientos Neuroquirúrgicos , Compresión de la Médula Espinal/etiología , Compresión de la Médula Espinal/cirugía , Enfermedades de la Columna Vertebral/cirugíaRESUMEN
The authors present a case of intramedullary ganglioglioma in a 6-year-old girl. Since the age of 4 months the patient had experienced a spontaneous wavy undulating movement of her anterior abdominal wall resembling a severe peristalsis. The movement was continuous even during sleep, and this symptom was named "belly dance." Magnetic resonance images revealed an intramedullary tumor with ill-defined borders, and the lesion was partially resected. The patient made a good recovery, although 4 years postsurgery her scoliosis had progressed.
Asunto(s)
Pared Abdominal/patología , Ganglioglioma/diagnóstico , Neoplasias de la Médula Espinal/diagnóstico , Niño , Diagnóstico Diferencial , Femenino , Ganglioglioma/diagnóstico por imagen , Humanos , Radiografía , Neoplasias de la Médula Espinal/diagnóstico por imagen , Vértebras Torácicas/patologíaRESUMEN
Alkaptonuria is a rare metabolic disease caused by deficiency of homogentisic acid oxidase and characterized by bluish-black discoloration of cartilages and skin (ochronosis). The authors report the cases of three patients with lumbar disc herniation who underwent discectomy and in whom the nucleus pulposus was discovered to be black. Alkaptonuria was diagnosed after discectomy. Discal herniation requiring surgery is unusual in alkaptonuria, with only a few reports. The symptoms in the three patients disappeared after surgery and no symptoms were demonstrated on follow-up examination.