Ligamentum flavum cysts causing incapacitating lumbar spinal stenosis.

BACKGROUND: Cysts of the ligamentum flavum are rare and unusual causes of spinal compression. METHODS: We report our experience of four cases of ligamentum flavum cysts occurring in the lumbar spine and discuss some of the possible etiologies and pathophysiologic mechanisms according to the available literature. CONCLUSION: This entity is clearly different from the synovial facet-joints or ganglion cysts.

Distal mycotic aneurysm of the AICA mimicking intracanalicular acoustic neuroma.

BACKGROUND: Among cases of cerebellopontine angle lesions, vascular lesions involving the internal auditory canal are extremely rare. We report a distal fusiform mycotic pseudoaneurysm of the anterior inferior cerebellar artery (AICA) that simulated an acoustic neuroma on presentation. METHODS: A 60-year-old woman was investigated for recent onset of acute dizziness. Laboratory and radiographic investigations are presented, as well as the surgical management of the patient and pathological examination of the aneurysm. CONCLUSIONS: An exceptionally rare case of distal mycotic intracanalicular pseudoaneurysm of the AICA with intraluminal thrombus and fusiform anatomy is described. In our review of the literature (1966-present), only five other intracanalicular AICA-aneurysms were encountered, none of which were infectious in etiology. The possible pathophysiologic mechanisms of distal AICA-aneurysms are discussed along with the currently available literature.

(1)H-MRSI evidence for cortical gray matter pathology that is independent of cerebral white matter lesion load in patients with secondary progressive multiple sclerosis.

We examined: (i) neuro-axonal disturbance (as indicated by (1)H-MRSI NA/Cr values) in the cortical grey matter (cGM) of 10 untreated patients with relapsing-remitting (RR) and 10 with secondary-progressive (SP) multiple sclerosis (MS), and (ii) the relationships between cGM-NA/Cr values and the degree of EDSS-measured clinical disability and cerebral white-matter (WM) lesion load (LL) in these patients. Whereas mean and median cGM-NA/Cr values in our RR group were similar to those in 18 age-matched normal controls (NC), large statistically-significant decreases (between 14.3% and 18.5%) were found in our SP group relative to both our RR and NC groups. When data from all patients was combined, we found: (i) a large negative correlation between EDSS scores and cGM-NA/Cr values (r=-0.55); and (ii) a larger negative correlation of cGM-NA/Cr values with cerebral T1-hypointese WM-LL (T1-LL, r=-0.73) than with cerebral T2-hyperintense-LL (T2-LL, r=-0.63). Importantly, (i) correlations of WM-LL with cGM-NA/Cr were larger in the RR group than in the SP group (T1-LL: r=-0.79 vs. -0.54; T2-LL: r=-0.63 vs. -0.51), and (ii) cerebral WM-LL values could not fully account for the extent of the decrease in mean cGM-NA/Cr that was seen in our SP group relative to our NC group. Our observations are consistent with the possibilities that: (i) in patients with RR-MS, (1)H-MRSI-measured cGM neuro-axonal disturbances are strongly related to the effects of axonal transection that are associated with cerebral WM lesions; and (ii) in patients with SP-MS, such cGM neuro-axonal disturbances are more severe and are associated with a more-widespread degenerative process (which probably includes a considerable degree of cortical demyelination).

Il Fasciculo di Medicina of 1493: medical culture through the eyes of the artist.

THE FASCICULUS MEDICINA, printed in 1491, is considered the first illustrated medical book. The Latin essays and illustrations in this volume provide insight into the medical knowledge of Western Europe and, in the Italian edition published in 1493, glimpses into the medical culture of the late 15th century. We outline the scientific and social environments into which the Fasciculus Medicinae of 1491 was introduced and the transition that occurred with the publication of the 1493 Italian edition. The artist of the 1493 Fasciculo witnessed a paradigm shift occurring. In four woodcuts, the artist captured four themes: the relevance of knowledge-based medicine, the emergence of laboratory medicine, the Hippocratic lessons of patient observation, and the emerging revolution in anatomy.

Dopamine genes and attention-deficit hyperactivity disorder: a review.

OBJECTIVE: To review the results of genetic studies investigating dopamine-related genes in attention-deficit hyperactivity disorder (ADHD). DATA SOURCES: Papers (association/linkage, meta-analyses and animal model studies) were identified through searches of the PubMed database and systematically reviewed. DATA SYNTHESIS: Consistent results from molecular genetic studies are pointing strongly to the possible link between 2 specific genes, the dopamine transporter (SLC3A6) and the dopamine receptor 4 (DRD4), and ADHD. CONCLUSIONS: The implication of SLC6A3 and DRD4 genes in ADHD appears to be one of the most replicated in psychiatric genetics and strongly suggests the involvement of the brain dopamine systems in the pathogenesis of ADHD. However, more work is required to further these findings by genotype-to-phenotype correlations and identify the functional allelic variants/mutations that are responsible for these associations. The role of other dopamine genes, which may have smaller effects than SLC6A3 and DRD4, needs also to be determined.