Cortical and Subcortical Brain Alterations in Specific Phobia and Its Animal and Blood-Injection-Injury Subtypes: A Mega-Analysis From the ENIGMA Anxiety Working Group.

OBJECTIVE: Specific phobia is a common anxiety disorder, but the literature on associated brain structure alterations exhibits substantial gaps. The ENIGMA Anxiety Working Group examined brain structure differences between individuals with specific phobias and healthy control subjects as well as between the animal and blood-injection-injury (BII) subtypes of specific phobia. Additionally, the authors investigated associations of brain structure with symptom severity and age (youths vs. adults). METHODS: Data sets from 31 original studies were combined to create a final sample with 1,452 participants with phobia and 2,991 healthy participants (62.7% female; ages 5-90). Imaging processing and quality control were performed using established ENIGMA protocols. Subcortical volumes as well as cortical surface area and thickness were examined in a preregistered analysis. RESULTS: Compared with the healthy control group, the phobia group showed mostly smaller subcortical volumes, mixed surface differences, and larger cortical thickness across a substantial number of regions. The phobia subgroups also showed differences, including, as hypothesized, larger medial orbitofrontal cortex thickness in BII phobia (N=182) compared with animal phobia (N=739). All findings were driven by adult participants; no significant results were observed in children and adolescents. CONCLUSIONS: Brain alterations associated with specific phobia exceeded those of other anxiety disorders in comparable analyses in extent and effect size and were not limited to reductions in brain structure. Moreover, phenomenological differences between phobia subgroups were reflected in diverging neural underpinnings, including brain areas related to fear processing and higher cognitive processes. The findings implicate brain structure alterations in specific phobia, although subcortical alterations in particular may also relate to broader internalizing psychopathology.

Cortical morphology changes in women with borderline personality disorder: a multimodal approach

Objective: Borderline personality disorder (BPD) is a devastating condition that causes intense disruption of patients' lives and relationships. Proper understanding of BPD neurobiology could help provide the basis for earlier and effective interventions. As neuroimaging studies of patients with BPD are still scarce, volumetric and geometric features of the cortical structure were assessed to ascertain whether structural cortical alterations are present in BPD patients. Methods: Twenty-five female outpatients with BPD underwent psychiatric evaluation (SCID-I and II) and a 1.5 T magnetic resonance imaging (MRI) brain scan. The control group comprised 25 healthy age-matched females. Images were processed with the FreeSurfer package, which allows analysis of cortical morphology with more detailed descriptions of volumetric and geometric features of cortical structure. Results: Compared with controls, BPD patients exhibited significant cortical abnormalities in the fronto-limbic and paralimbic regions of both hemispheres. Conclusion: Significant morphologic abnormalities were observed in patients with BPD on comparison with a healthy control group through a multimodal approach. This study highlights the involvement of regions associated with mood regulation, impulsivity, and social behavior in BPD patients and presents a new approach for further investigation through a method of structural analysis based on distinct and simultaneous volumetric and geometric parameters. .

Middle cerebral artery revscularization: anatomical studies and considerations on the anastomosis site

In the surgical management of skull base lesions and vascular diseases such as giant aneurysms, involvement of the internal carotid artery may require the resection or the occlusion of the vessel. The anastomosis of the external carotid artery and the middle cerebral artery with venous graft may be indicated to re-establish the blood flow. To determine the best suture site in the middle cerebral artery, an anatomical study was carried out. Fourteen cerebral hemispheres were analysed after the injection of red latex into the internal carotid artery. The superior and inferior trunk of the main division of the middle cerebral artery have more than 2 mm of diameter. They are superficial allowing an anastomosis using a venous graft. The superior trunk has a disadvantage, it gives rise to branches for the precentral and post-central giri. The anastomosis with the inferior trunk presents lower risk of neurological deficit even though the angular artery originates from it.

Proteína S100B no lúpus eritematoso sistêmico com envolvimento neuropsiquiátrico / S100B protein in systemic lupus erythematosus with neuropsychiatric involvement

Não existem bons marcadores de dano e atividade de doença no envolvimento neuropsiquiátrico do lúpus eritematoso sistêmico. Níveis elevados da proteína S100B no soro e no liquor têm sido estudados como marcadores de dano cerebral. Objetivo: Estudar os níveis séricos da proteína S100B no lúpus neuropsiquiátrico e correlacioná-los com achados de exames de imagem. Métodos: Concentrações da proteína S100B no soro foram avaliadas por meio de quimiluminescência em 48 pacientes lúpicos (LESNPS) com ou sem sintomas neurosiquiátricos (LES). Vinte e três pacientes foram estudados usando ressonância magnética (RM) e tomografia computadorizada de emissão fotônica única (SPECT). Resultados: Pacientes com LESNP apresentaram um número aumentado de lesões de substância branca (LSB) maiores ou iguais a 6 mm, comparado aos pacientes com LES sem envolvimento neuropsiquiátrico (p= 0,028). Todos os pacientes com lúpus eritematoso sistêmico (com ou sem sitomas neuropsiquiátricos) apresentaram níveis séricos elevados da proteína S100B em comparação com os controles normais. Pacientes com LESNPS apresentaram níveis significativamente mais elevados da proteína S100B do que os pacientes com LES (p < 0,0001). Foi encontrada correlação entre o índice de atividade da doença (SLEDA), a concentração sérica da proteína S100B e o número de LSB 6 mm (p= 0,0082). Conclusões: Os achados demonstraram níveis séricos elevados da proteína S100B no envolvimento neuropsiquiátrico do LES. Será necessário estudar um número maior de pacientes para correlacionar estes níveis elevados com as diversas formas de apresentação desta complicação e com os achados dos exames de imagem.