From paradigm to paradox: divergency between intracranial pressure and intracranial pulse pressure during atmospheric pressure fall. A case study.

BACKGROUND: The main objectives are to determine relation between intracranial pressure (ICP) and its amplitude and to ascertain meteorological variables as possible confounding factors. This is a retrospective observational study of a patient with suspicion of normotensive hydrocephalus. METHODS: The intracranial pressure, the blood pressure, atmospheric pressure and geomagnetic activity were continuously monitored capturing extraordinary sudden and unexpected atmospheric pressure fall. The physiological changes exceptionally observed during sudden weather changes were described by means of statistical parameters. The data from 73 consecutive hourly measurements was eligible for this analysis. It contained 1022 data points corresponding to all recorded parameters, both climate and physiological ones. RESULTS: After initial stable period, the atmospheric pressure started to decrease from 767 mmHg to 746 mmHg. In parallel, the mean ICP ncreased significantly from 4 mmHg to 14 mmHg. Thus, the mean ICP changed inversely during atmospheric pressure drop. Whereas mean intracranial pressure increased by 10 mmHg during atmospheric pressure fall, the intracranial amplitude decreased by 5 mmHg. On timescale of several dozen hours in this study, the short-term periodic diurnal variations of ICP and blood pressure were displayed. The association between diurnal atmospheric pressure oscillation and geomagnetic activity variation was observed. Both intracranial and blood pressure variations differed significantly between day and night. CONCLUSIONS: This study shows that increasing ICP is associated with its paradoxically decreasing amplitude under the influence of sudden and unexpected barometric pressure fall. This study suggests that abrupt changes in atmospheric pressure might impact ICP.

Circadian Biorhythmicity in Normal Pressure Hydrocephalus - A Case Series Report.

Continuous monitoring of intracranial pressure is a well established medical procedure. Still, little is known about long-term behavior of intracranial pressure in normal pressure hydrocephalus. The present study is designed to evaluate periodicity of intracranial pressure over long-time scales using intraventricular pressure monitoring in patients with normal pressure hydrocephalus. In addition, the circadian and diurnal patterns of blood pressure and body temperature in those patients are studied. Four patients, selected with "probable" normal pressure hydrocephalus, were monitored for several dozen hours. Intracranial pressure, blood pressure, and body temperature were recorded hourly. Autocorrelation functions were calculated and cross-correlation analysis were carried out to study all the time-series data. Autocorrelation results show that intracranial pressure, blood pressure, and body temperature values follow bimodal (positive and negative) curves over a day. The cross-correlation functions demonstrate causal relationships between intracranial pressure, blood pressure, and body temperature. The results show that long-term fluctuations in intracranial pressure exhibit cyclical patterns with periods of about 24 hours. Continuous intracranial pressure recording in "probable" normal pressure hydrocephalus patients reveals circadian fluctuations not related to the day and night cycle. These fluctuations are causally related to changes in blood pressure and body temperature. The present study reveals the complete loss of the diurnal blood pressure and body temperature rhythmicities in patients with "probable" normal pressure hydrocephalus.

Missing Skeletal Muscle Metastases of Papillary Thyroid Carcinoma.

With regard to several important gaps in the work "Skeletal Muscle Metastasis in Papillary Thyroid Microcarcinoma Evaluated by F18-FDG PET/CT" [...].

Incidental detection of unexpected neck lymphatic III level node metastasis from occult papillary thyroid carcinoma during cervical disc surgery: first literature report.

Not required for Clinical Vignette.

Expanding Cyst of the Septum Pellucidum - Endoscopic Observations on the Mechanism of Development and Results of Treatment.

Cysts of the septum pellucidum (CSP) are usually asymptomatic; however, in some cases they can begin expanding and cause neurological deterioration. The mechanism leading to the formation of an expanding cyst of the septum pellucidum (ECSP) is not known. Based on observations made during endoscopic treatment of ECSP we analyzed intraoperative findings in respect to cyst formation mechanism and treatment prognosis. A group of 31 patients was studied. Only cases with bulging cyst walls occupying the frontal horns observed on imaging studies were included. The main symptom was a severe, intermittent headache. In three cases short term memory deficits were diagnosed. In one case papilloedema was observed. All patients underwent endoscopic fenestration of the ECSP. There were no cases of cyst reocclusion during a follow-up period of 1-14 years (mean 6.2 years). In 30 cases headaches resolved completely and in one case its intensity was significantly smaller. There was one case of postoperative hemiparesis. In all but two cases the thin, translucent region in the anterior part of the cyst floor was found. In the region small fissures and in three cases choroid plexus were observed. Endoscopic fenestration is the efficient treatment for ECSP. ECSP is formed on the basis of not completely closed, developmental communication of the cyst with other fluid spaces. The communication is opened by transient elevation of intraventricular pressure, and acts as a valve leading to fluid accumulation among the walls of the previously asymptomatic cavum septum pellucidum.

Skeletal muscle metastases from papillary and follicular thyroid carcinomas: An extensive review of the literature.

Skeletal muscle metastasis of papillary or follicular thyroid cancer (PTC/FTC) is a rare finding; only 11 cases of skeletal muscle PTC or FTC metastasis have been included in medical literature reviews. The aim of this study was to identify all published cases of PTC and FTC muscle metastases and derive the true incidence of this malignancy. The probability of detecting the skeletal muscle metastasis of PTC and FTC was calculated based on epidemiological data. Databases of scientific literature on the Internet were searched for articles using relevant key words. The analysis of epidemiological data calculated the probability of detecting skeletal muscle lesions of this type as approximately zero. The literature search revealed 44 published international papers, reporting 58 cases of PTC or FTC skeletal muscle metastasis in 45 patients over 110 years, from 1907 to 2017. The most frequent PTC/FTC metastatic muscle was the gluteus. The majority of cases of muscle metastasis were caused by PTC, and metastatic tumors in the skeletal muscle negatively impacted the survival of patients with PTC or FTC.

Massa versus Haller: Priority of the Cerebrospinal Fluid Discovery.

The commonly accepted practice in recognizing the scientific priority of a discovery requires finding a hitherto unknown phenomenon, publishing it to other scholars and doing it for the first time. And this is what happened regarding the discovery of the intracranial fluid presence by the Venetian anatomist Massa in 1536. This finding fulfills all the conditions necessary for the recognition of the scientific discovery.

The major influence of the atmosphere on intracranial pressure: an observational study.

The impact of the atmosphere on human physiology has been studied widely within the last years. In practice, intracranial pressure is a pressure difference between intracranial compartments and the surrounding atmosphere. This means that gauge intracranial pressure uses atmospheric pressure as its zero point, and therefore, this method of pressure measurement excludes the effects of barometric pressure's fluctuation. The comparison of these two physical quantities can only take place through their absolute value relationship. The aim of this study is to investigate the direct effect of barometric pressure on the absolute intracranial pressure homeostasis. A prospective observational cross-sectional open study was conducted in Szczecin, Poland. In 28 neurosurgical patients with suspected normal-pressure hydrocephalus, intracranial intraventricular pressure was monitored in a sitting position. A total of 168 intracranial pressure and atmospheric pressure measurements were performed. Absolute atmospheric pressure was recorded directly. All values of intracranial gauge pressure were converted to absolute pressure (the sum of gauge intracranial pressure and local absolute atmospheric pressure). The average absolute mean intracranial pressure in the patients is 1006.6 hPa (95 % CI 1004.5 to 1008.8 hPa, SEM 1.1), and the mean absolute atmospheric pressure is 1007.9 hPa (95 % CI 1006.3 to 1009.6 hPa, SEM 0.8). The observed association between atmospheric and intracranial pressure is strongly significant (Spearman correlation r = 0.87, p < 0.05) and all the measurements are perfectly reliable (Bland-Altman coefficient is 4.8 %). It appears from this study that changes in absolute intracranial pressure are related to seasonal variation. Absolute intracranial pressure is shown to be impacted positively by atmospheric pressure.

The maze of the cerebrospinal fluid discovery.

The author analyzes a historical, long, and tortuous way to discover the cerebrospinal fluid. At least 35 physicians and anatomists described in the text have laid the fundamentals of recognition of this biological fluid's presence. On the basis of crucial anatomical, experimental, and clinical works there are four greatest physicians who should be considered as equal cerebrospinal fluid's discoverers: Egyptian Imhotep, Venetian Nicolo Massa, Italian Domenico Felice Cotugno, and French François Magendie.

Assessment of economic effectiveness in treatment of neuropathic pain and refractory angina pectoris using spinal cord stimulation.

BACKGROUND: The implementation of new diagnostic and therapeutic technologies is related to expanding financial needs. The escalation of expenses for health protection and simultaneous economic problems has resulted in an interest in the subject of economic assessment. Decision makers in the health sector should have reasonable tools that will allow them to make complex evaluations of the economic suitability of health technologies. Economic analysis should also prove that launching new procedures can save money. Numerous studies indicate that chronic pain and psycho-sociological variables lead to a worse quality of life. Chronic pain issues are a major public health problem, by virtue of the difficulties in efficient therapy and the social costs reflected in incapability of work and disability. Spinal cord stimulation is the most efficacious procedure in the treatment of chronic pain. OBJECTIVES: The aim of the study was to estimate the costs of treatment of 37 patients suffering from refractory angina pectoris and neuropathic pain who underwent SCS surgery between 2002 and 2008 in the Neurosurgery Clinic of the 10th Military Hospital in Bydgoszcz in the period of two years before and two years after spinal cord stimulation. The authors also assessed quality of life, using the SF 36 questionnaire, and degree of pain using VAS. MATERIAL AND METHODS: The issue was examined with a cost-benefit analysis. Cost was understood as the expenses made two years before and two years after the SCS procedure. The benefits were health care expenses saved by implementation of the SCS procedure. All the costs included in both alternative treatment techniques in a period of 5 years underwent a discounting procedure. The authors also included the price of the neurostimulator under a sensitivity analysis. To assess the quality of life before and after the SCS procedure, a SF 36 questionnaire was used, and to assess the level of pain before and after the SCS procedure, the VAS scale. RESULTS: The costs of treatment of refractory angina pectoris and neuropathic pain are lower when using spinal cord stimulation. In the case of refractory angina pectoris, savings reached 46% whereas in the case of neuropathic pain, 13.2%. The costs of the purchase of the device returned in three years for angina pectoris and seven years for neuropathic pain. SCS in both cases brought a reduction of the level of pain and an improvement to quality of life. CONCLUSIONS: SCS in both neuropathic pain and refractory angina pectoris is a procedure that brings benefits in the form of savings. After using SCS in both cases, the quality of life improved and the level of pain was reduced.

Pseudomeningeal syndrome of Dupre associated with cervical discopathy--case report.

BACKGROUND AND PURPOSE: The below publication presents a case of a 51-year-old patient with cervical discopathy of unusual clinical course. CASE REPORT: The symptoms of the disease suddenly became aggravated and took a form of meningeal syndrome without inflammation of cerebrospinal fluid. The authors emphasize the symptomatology and diagnostic difficulties connected to unusual clinical course of cervical discopathy at the level of VC3/VC4. DISCUSSION: Both medical and neurosurgical approaches to clinical history of cervical discopathic patient were presented in details. The patient underwent anterior cervical interbody fusion and the operative procedure was very effective for a few years up till now.

Experimental determination of the Stern layer thickness at the interface of the human arachnoid membrane and the cerebrospinal fluid.

The paper is part of an investigation of the electrostatic forces contributing to the interaction between colloidal molecules, suspended in the cerebrospinal fluid, with other molecules of the cerebrospinal fluid and with the surrounding environment. The study is based on experimental observations and theoretical considerations. We are reporting about the microscopic observation of particles suspended in the cerebrospinal fluid which was obtained by lumbar puncture of 27 neurosurgery patients. We found that the mean particle diameter and therefore the mean thickness of the Stern layer at the interface of the arachnoid membrane with the cerebrospinal fluid is a few micrometers. Individual variations of this diameter have been observed.

Atmospheric pressure and basic parameters of intracranial volume-pressure homeostasis.

BACKGROUND AND PURPOSE: There are only a few studies in the literature regarding the influence of atmospheric pressure on intracranial homeostasis and the mechanism of the relation has not been clarified. The aim of the study was to evaluate the influence of atmospheric pressure and ambient temperature on parameters of intracranial volume-pressure homeostasis including intracranial pressure and cerebral perfusion pressure as well as on blood pressure and body temperature. MATERIAL AND METHODS: The authors analyzed the influence of atmospheric pressure on intracranial pressure, blood pressure, cerebral perfusion pressure and body temperature in 14 patients who were monitored because of suspicion of having normal pressure hydrocephalus. RESULTS: Atmospheric pressure below 760 mm Hg (1013.3 hPa) significantly affects intracranial pressure, arterial blood pressure, cerebral perfusion pressure and body temperature. Atmospheric pressure above 770 mm Hg (1026.6 hPa) does not affect intracranial pressure, arterial blood pressure, cerebral perfusion pressure or body temperature. CONCLUSIONS: Atmospheric pressure range of 768 mm Hg (1023.9 hPa) to 770 mm Hg (1026.6 hPa) is the border range to preserve intracranial homeostasis, below which qualitative changes of cerebral blood flow occur. In the high range of atmospheric pressure its increase initiates biological protective mechanisms to maintain normal cerebral blood flow. The mechanism involved in the influence of atmospheric pressure and environmental factors in general on intracranial pressure and other parameters of pressure-volume homeostasis has not been explained.