Fahr syndrome and neurological manifestations in hypoparathyroidism patients.

Fahr syndrome is an uncommon (prevalence < 1/1.000.000) neurological disorder characterized by abnormal calcified deposits in the basal ganglia, nucleus dentatus, and cerebral cortex. These calcification can lead to various neurological manifestations. Distinguishing Fahr syndrome from Fahr disease is crucial due to differences in their etiology, location of lesions, prognosis, and therapy. Currently, Fahr disease lacks a specific treatment, while Fahr syndrome requires target intervention based on the underlying cause. A 35 years old female patient was presented to the emergency department with recurrent tonic-clonic seizures followed by the decreased consciousness. The patient had history of thyroidectomy surgery 7 years before, behavioral disturbances, hallucinations for past 1 week, and cataracts in both eyes. Laboratory examination showed low calcium levels (4 mg/dL), which can trigger seizures, and low PTH levels, indicating hypoparathyroid. A head CT scan without contrast displayed extensive bilateral calcification, particularly in the basal ganglia. Following stabilization, an EEG recording discovered diffuse encephalopathy. The patient received seizure management and maintenance medication of calcium with vitamin D. During the 3 months follow up, no sign of relapses were observed. Intracranial calcifications are often physiological but should be suspected as pathology in certain symptoms and calcification patterns. The presence of multiple intracranial calcifications, specifically in the basal ganglia, indicates Fahr disease or Fahr syndrome, which can cause various neurological manifestations. One of the etiologies of Fahr syndrome to consider is hypoparathyroid. Therefore, identifyisng and managing this etiology is crucial for preventing the progression of Fahr syndrome.

Spontaneous thrombosis of deep brain arteriovenous malformation in a patient with intraventricular and subarachnoid hemorrhage.

The most common manifestation of brain arteriovenous malformations (BAVM) is intracranial hemorrhage. The incidence of ruptured BAVM is 3.5 per 100,000 people per year. The mortality rate of ruptured BAVM within 1 month after diagnosis was 12.7%. Spontaneous thrombosis occurs in less than 1.5% of ruptured BAVMs. This phenomenon was still elusive. Up until now, the gold standard of imaging examination has been cerebral digital subtraction angiography (DSA), whose sensitivity and specificity reach 100%. We reported the spontaneous thrombosis of a ruptured deep BAVM. An 18-year-old woman presented with severe headache and vomiting. The patient also complained of seizures. There was no body weakness, skewed face, or slurred speech. Cerebral computed tomography (CT) showed extensive hemorrhage in the ventricular system and subarachnoid space. Cerebral DSA showed a left subcortical BAVM and was found to have spontaneous thrombosis 3 weeks later when the patient was about to be embolized. Spontaneous thrombosis of ruptured BAVM may occur after intracranial hemorrhage. In this patient, spontaneous thrombosis occurred within 3 weeks.

Locked-in syndrome caused by extracranial and intracranial takayasu arteritis: A rare case report and radiological findings.

Locked-in syndrome (LiS) is a condition of motor paralysis involving all the voluntary muscles of 4 extremities with retained consciousness and alertness. Meanwhile, Takayasu arteritis (TA) is a systemic inflammatory disease affecting large arteries, including the aorta and the branches. This disease often affects the extracranial arteries but rarely occurs in the intracranial arteries. An 18-year-old male presented with a sudden onset of decreased consciousness and bilateral weakness. The patient exhibited normal horizontal and vertical eye movements but presented with impairment of the trigeminal nerve, peripheral-type facial palsy, absence of gag reflex and tongue movement, and neck weakness. Physiological reflexes were increased bilaterally, while pathological reflexes were present on both sides. Autonomic function was impaired, and communication was impossible due to paralysis. Additionally, the patient displayed varying blood pressure readings between the right and left arms. The antinuclear antibody (ANA) and antismooth muscle (ASMA) antibody tests yielded negative results, while the electroencephalogram (EEG) showed normal readings. The cerebral angiogram indicated multiple internal and external stenoses, with total stenosis evident in the basilar artery. The patient was diagnosed with multiple extracranial and intracranial stenoses due to TA. Total stenosis of the basilar artery resulted in brainstem infarction, which led to the development of LiS. Meanwhile, the disturbance of the motor tracts in the ventral brainstem was the underlying cause of the LiS. This case report demonstrated a variety of atypical presentations of TA. The involvement of multiple extracranial and intracranial arterial was attributed to LiS.

A rare case report of spontaneous thrombosis in unruptured giant intracranial aneurysm.

Unruptured giant intracranial aneurysms (GIAs) are characterized by their size, which exceeds 25 mm, and these conditions account for approximately 5% of all aneurysm cases. Furthermore, it typically develops in women during the fifth to seventh decade of life. Compared to small aneurysms, which cause subarachnoid hemorrhage, GIAs can manifest as masses or ischemic effects caused by thromboembolism. An elderly female patient, aged 67, was admitted to the hospital with a primary complaint of sudden facial sensory loss on the left side and vomiting. There was also a history of double vision accompanied by left ocular movement disturbance and gradually developed localized headache on the left side. Furthermore, a contrast head magnetic resonance angiography (MRA) revealed the presence of a high-flow giant aneurysm, measuring 30.7 × 31.8 × 27.2 mm in the cavernous segment of the left internal carotid artery (ICA). Cerebral angiography showed the absence of flow on the left ICA due to total occlusion. After cerebral angiography, the patient remained conscious but exhibited some neurological deficits, which were identical to the initial symptoms observed during hospitalization. Cases of spontaneous thrombosis in GIA are extremely rare. However, radiological examination, particularly angiography, can be used to diagnose spontaneous thrombosis in unruptured GIAs to ensure that the patient receives the right treatment.

Spontaneous subdural hematoma concomitant with subarachnoid hemorrhage and intracerebral hemorrhage due to ruptured brain arteriovenous malformation treated with curative embolization.

Introduction: An arteriovenous malformation (AVM) consists of a tangled cluster of dilated blood vessels forming anomalous communication between arterial and venous systems without capillary bridging. The most likely manifestations of a ruptured AVM are intracerebral hemorrhage (ICH), subarachnoid hemorrhage (SAH), or intraventricular hemorrhage (IVH). Subdural hematoma (SDH) is exceptional in cases of ruptured brain arteriovenous malformation (BAVM). Case Report: A 30-year-old female was referred to the Emergency Room with a major complaint of sudden thunderclap headache 1 day before admission. The patient also complained of double vision and left ptosis that lasted for 1 day. There was no other complaint or history of hypertension, diabetes, or trauma. Non-contrast head computed tomography (CT) showed ICH-SAH-SDH on the left side of the brain which was not typical of a hypertensive pattern. The secondary ICH has a score of 6, indicating that 100% of the bleeding might be caused by underlying vascular malformation. Furthermore, cerebral angiography showed cortical plexiform BAVM on the left occipital lobe, and the patient underwent curative embolization. Discussion: Spontaneous SDH is very rare, and there are some hypotheses about the reasons for its occurrence. First, brain movement stretches the arachnoid layer that adheres to the AVM, resulting in direct bleeding into subdural space. Second, high-flow pia-arachnoid ruptured blood might extravasate into subdural space. Finally, the ruptured cortical artery that connects the cortex and dura layer (bridging artery) might also cause SDH. Some scoring systems are useful in BAVM, and this study selected endovascular embolization for the patient. Conclusion: Brain AVM rupture usually causes ICH, SAH, or IVH. Clinicians must be more aware of spontaneous SDH because it might be caused by a vascular malformation, although it is rare.

Limb shaking movement as a rare manifestation of transient ischemic attacks caused by carotid stenosis disease: A case report.

A limb shaking TIA is a less common form of TIA that manifests as involuntary movement and is frequently confused with focal motor epilepsy. A 64-year-old female presented with a 7-month history of episodic involuntary shaking movements affecting her left arm and leg before admission. These attacks primarily occurred after she rose from a sitting or lying down position to a standing position, and were relieved by simply returning to a sitting or lying position. A neurological examination revealed no motor or sensory deficits in either extremity. Her magnetic resonance angiogram (MRA) and carotid Doppler revealed right ICA stenosis in her brain. It is important to distinguish this limb shaking TIA from other conditions such as focal motor seizures. Importantly, early detection and treatment of the associated carotid artery occlusion can not only prevent the patient's TIA episode, but also lower the risk of future stroke.

A rare case of spontaneous thrombosis in saccular cerebral aneurysm in a patient with subarachnoid hemorrhage.

Cerebral aneurysm is a known cause of spontaneous subarachnoid hemorrhage (SAH). Furthermore, this condition is often asymptomatic, but the occurrence of a rupture can lead to fatal complications. The incidence of spontaneous thrombosis in saccular aneurysm is rare, with an incidence rate of 1%-2%. The most common sites include the middle cerebral artery (MCA) (41%), posterior communicating artery (PCOMM) (15%), and posterior inferior cerebellar artery (PICA) (11%). A head computed tomography angiography (CTA) with contrast is a common diagnostic tool for detecting SAH in the temporoparietal area, hippocampal gyrus, and right fissure of Sylvie. In some cases, saccular aneurysm can be found in the segment bifurcation of the right middle cerebral artery. A cerebral angiography was carried out, specifically digital subtraction angiography, which revealed the presence of visible blister remnants of aneurysm in the form of spontaneous thrombosis. After 1 year, another angiography evaluation was performed to assess the condition of the patient. Furthermore, the results showed no evidence of recanalization and there were no new neurologic deficits. Although spontaneous thrombosis led to the healing of aneurysm in some cases, secondary recanalization remained a possibility. Therefore, it was essential to monitor any incidence of this complication. Precise knowledge of the mechanism of spontaneous thrombosis could lead to the development of new therapeutic approaches. Spontaneous thrombosis in cases of saccular aneurysm is a rare occurrence, which can provide temporary or permanent benefits to the patient. Therefore, periodic evaluation is required to assess the condition of the patient.

Bilateral gradual cortical blindness due to hemodynamic stroke: A case report.

Cortical blindness refers to the loss of vision caused by a lesion affecting the geniculate calcarine visual pathway. Bilateral occipital lobe infarctions in the vascular territory of the posterior cerebral arteries are the most common cause of cortical blindness. However, bilateral cortical blindness gradual is rarely reported. Gradual bilateral blindness usually occurs in lesions other than stroke, such as tumors. We report a case of a patient with gradual cortical blindness caused by a nonocclusive stroke caused by hemodynamic compromise. A 54-year-old man diagnosed with bilateral cerebral ischemia after complaining of bilateral gradual vision loss and headache for 1 month. Initially, he only complained of blurred vision with >2/60 vision. However, his visual acuity worsened until he could only see hand movements and only light perception later on (with visual acuity of 1/∼). A computed tomography scan of the head revealed a bilateral occipital infarction, and cerebral angiography revealed multiple stenoses and near-total occlusion of the left vertebral artery ostium, underwent angioplasty and stenting. He has received dual antiplatelet and antihypertensive treatment. He got visual improvement with visual acuity 2/300 after 3 months of the treatment and procedure. Gradual cortical blindness caused by hemodynamic stroke is rare. The most common cause of posterior cerebral arteries infarction is embolism from the heart or vertebrobasilar circulation. With proper management and focusing on treating the etiology of these patients, vision improvements can be obtained in these patients.

Chronic pulsatile tinnitus and continuous vertigo due to very delayed diagnosis of single slow-flow dural arteriovenous.

Tinnitus and vertigo are classic symptoms of inner ear disease. Dural arteriovenous fistulas (DAVF) are a rare type of acquired intracranial vascular malformation whose symptoms mimic inner ear disease, but what distinguishes it from other tinnitus is the characteristic of DAVF is pulsatile and heartbeat-synchronous. We present a 58-year-old male with chronic left-sided pulsatile tinnitus (PT) for 30 years and continuous vertigo for 3 years that took numerous consultations to establish a diagnosis after the onset of symptoms. Delay in diagnosis is caused by normal magnetic resonance imaging and an unrecognized subtle mass in the left temporal region by time-of-flight magnetic resonance angiography (TOF-MRA) at the screening test. As we know, TOF-MRA could not provide a clear picture to establish a slow-flow DAVF. Cerebral angiography, a gold standard diagnostic, revealed a Borden/ Cognard Type I single slow-flow DAVF in the left temporal region. The patient was treated with superselective transarterial embolization. After 1 week of follow-up, the symptoms of vertigo and PT were completely resolved.

Delayed Cerebral Ischemia after Embolization in Ruptured Spinal Arteriovenous Fistula with Subarachnoid Hemorrhage : A Case Report.

Delayed cerebral ischemia (DCI) remains a devastating complication in subarachnoid hemorrhage (SAH), however, there were no present reports that is associated with a ruptured spinal arteriovenous fistula (sAVF). We would like to present a rare case of DCI following embolization of a ruptured perimedullary sAVF. Initially, the patient clinical symptoms mimic a SAH caused by a ruptured intracranial aneurysm. Further evaluation revealed that the SAH was caused by a ruptured perimedullary sAVF and the patient's condition improved following the embolization procedure. Three days later, the patient developed an acute left-sided facial and motor weakness, which persisted until the patient was discharged on the day-15 onset. A magnetic resonance imaging and angiography is performed 1.5 years after discharge and revealed no signs of cerebral infarction and hemorrhage. In this paper, we reported DCI after embolization in a ruptured sAVF with SAH, supported by evidence from the current literature. We would like to also stress the importance of complete spinal and cerebral vessel imaging to reveal the underlying abnormalities and determine the most appropriate intervention.

Acute subdural hematoma during sexual intercourse due to an aneurysm rupture on posterior communicating artery: a case report.

Patients with an acute subdural hematoma (aSDH) usually have a history of head trauma, but some patients may present with spontaneous aSDH due to a ruptured aneurysm. Spontaneous aSDH is a rare manifestation of aneurysmal rupture. However, aneurysmal rupture remains a major cause of spontaneous aSDH. A 42-year-old man was brought to the emergency room because of a sudden loss of consciousness during sexual intercourse. The patient has seizures and weakness on the right side of his body. The patient has no history of trauma and has never taken anticoagulant or antiplatelet drugs, sexual aphrodisiacs, or other drugs. Physical examination revealed the Glasgow Coma Scale of E2V1M3, ptosis on the left eye, left pupil mydriasis, right central facial palsy, and right hemiparesis. Laboratory results showed hypercoagulopathy. Noncontrast head computed tomography scan revealed subdural hematoma with no subarachnoid or intraparenchymal hemorrhage. The patient underwent an emergency craniotomy, and the hematoma was evacuated. Cerebral angiography was performed 1 week later, revealing a saccular aneurysm in the left posterior communicating artery. The patient has successfully undergone endovascular coiling and was discharged from the hospital in good condition, fully conscious, with no weakness in half side of the body, but there is still third nerve palsy. Patients with pure aSDH without a history of trauma should consider the possibility of aneurysm rupture and perform an angiographic examination to rule out vascular malformations so that the patient can receive appropriate treatment.

Functional roles of lncRNA-TUG1 in hepatocellular carcinoma.

Hepatocellular carcinoma (HCC) or hepatoma is malignant cancer that starts from the main liver cells. Although various classical methods have been used for patients with HCC, various molecular mechanisms involved in HCC progression should be invested. Previous studies demonstrated that abnormal expression of long non-coding RNAs (lncRNAs) presented important roles in the pathogenesis of HCC cells. LncRNA TUG1 was found to mediate HCC cell growth, EMT, and metastasis. Therefore, targeting TUG1 and its downstream genes may be a suitable approach for patients with HCC. In this review, we summarized the potential roles of TUG1 in HCC.

Intravenous thrombolysis in patient with vertebrobasilar dolichoectasia and antiplatelet medication.

Introduction: While the overall incidence of vertebrobasilar dolichoectasia (VBD) is less than 0.05%-0.06%, it is not uncommon in patients experiencing acute stroke. The influence of VBD on the outcome of intravenous (IV) thrombolysis therapy has not been widely studied. We present the following case of IV thrombolysis use in a patient experiencing acute stroke, who had an increased risk of bleeding due to prior antiplatelet use, and who had concomitant VBD. Case presentation: A 62-year-old man presented with weakness in the left extremities that had begun 1 hour prior to admission. The patient had a history of coronary artery disease and had been regularly taking antiplatelet medication. Upon arrival, the patient was in a decreased level of consciousness, with severe dysarthria, left central facial palsy, left lateralization, and a National Institute of Health Stroke Scale (NIHSS) score of 17. Computed tomography scan of the head showed no intracranial hemorrhage. The patient was administered IV thrombolysis at 2 hours and 45 minutes after symptom onset. Within the first 24 hours, the patient's NIHSS score decreased from 17 to 12, and the final NIHSS score prior to discharge was 7. The Head and neck angiography of this patient revealed VBD. Conclusion: This case demonstrated that IV thrombolysis is safe and effective for use in patients with acute ischemic stroke who have a history of antiplatelet usage and who experience concomitant VBD.

Recurrent stroke syndrome without abnormality on magnetic resonance imaging caused by stenosis of middle cerebral artery: A case report.

Middle cerebral artery stenosis is the leading and the most frequent cause of stroke due to intracranial stenosis in Asia. Magnetic resonance imaging (MRI) is more sensitive than computed tomography of the head for detecting acute brain ischemia. We are reporting a case of a 28-year-old female with recurrent left hemiparesis. After the last attack, an improvement in motor function was seen in less than 24 hours. Though the restoration of motor functions is not complete yet, an MRI scan that was done two weeks later appeared normal. Ischemic stroke in middle cerebral artery stenosis is associated with hemodynamic stroke due to hypoperfusion or lack of blood flow to brain tissue. Recurrent strokes can be prevented by better medical management in patients through regulation and management of risk factors.

Production of Inflammatory Mediators in Conditioned Medium of Adipose Tissue-Derived Mesenchymal Stem Cells (ATMSC)-Treated Fresh Frozen Plasma.

BACKGROUND Inflammation is the body's first response to an illness that causes irritation or infection. Inflammation is tightly correlated with aging, which is a progressive degenerative process. Conditioned medium (CM) from adipose tissue-derived mesenchymal stem cells (CM-ATMSCs) has been shown to stimulate collagen synthesis and dermal fibroblast migration, as well as reduce wrinkles and improve wound healing. This study aimed to observe the production of inflammatory modulators - interleukin (IL)-1alpha, IL-6, IL-10, and nuclear factor kappa-light-chain-enhancer of activated B cells (NF-kappaB) - in CM-ATMSCs treated with fresh frozen plasma (FFP) at passages 3 (P3), 7, 11, and 15. MATERIAL AND METHODS ATMSCs P3 were obtained from liposuction of female donors, and the CM from ATMSCs was collected. Measurement of these cytokines was performed with ELISA. RESULTS At many passages, IL-6, a proinflammatory modulator, was discovered to be the most powerful modulator among FFP- and non-FFP-treated cells. However, CM-ATMSCs treated with FFP and in the late passage have significant differences (P<0.05) compared to non-FFP treatments and in other passages in their effects on secretion of inflammatory modulators. CONCLUSIONS In conclusion, CM-ATMSC has the potential to secrete proinflammatory modulators.

What Are the Predictors of Intracranial Aneurysm Rupture in Indonesian Population Based on Angiographic Findings? Insight from Intracranial Aneurysm Registry on Three Comprehensive Stroke Centres in Indonesia.

Objectives: What are the Predictors of Intracranial Aneurysm (IA) Rupture based on angiographic findings among patients in Indonesia's Population Based on Angiographic Findings. Materials and Methods: We conducted a cross-sectional study on subjects with IA not caused by congenital aetiologies or other vascular malformations with cerebral angiography performed from January 2017 to January 2021. Demographic data and aneurysm profile, which include aneurysm count, size, location, and rupture event, were collected. The correlation between risk factors and IA rupture events was determined using bivariate and multivariate analysis. Results: From 100 angiography data (33 males and 67 females), the mean subject age is 51.94 ± 10.78. We observe a total of 121 IAs from all subjects. Most of the IAs are in the anterior circulation (104 aneurysms, 85.96%), have small size (77 aneurysms, 63.64%), and are found in ruptured conditions (90 aneurysms, 74.38%). Males have a greater aneurysm count (1.36 ± 0.74 vs. 1.13 ± 0.55, p = 0.036) and larger aneurysm size (p = 0.002). Aneurysm size is significantly correlated with its location (p = 0.008). Medium size (p = 0.019; OR 2.62, 95% CI 1.08-6.36) and location other than the internal carotid artery are associated with increased rupture event. Multivariate analysis revealed that gender (p = 0.031; aOR 5.37, 95% CI 1.17-24.70) is a significant risk factor of IA rupture event. Conclusion: IA profiling will enable clinicians to determine the risk of rupture and treatment plans for the Indonesian population. Further studies with a larger sample size are required to confirm these findings.

Identification Acroporidae and Favidae by a newly approach called Reef Identification Knowhow Application-Reconstructed by 3D Imagery (RIKA-R3DI) Method.

With an increase on coral reefs vulnerability worldwide, an efficient and an integrated monitoring technique are required. Photographic and video methods are now becoming more attractive rather than conventional technique to optimize diver time. In this research, the level of effectiveness of RIKA-R3DI method was evaluated using Agisoft Photoscan. The method was based on the reconstructed images in three dimensional image assisted by a computer with Agisoft Photoscan to facilitate data processing. This research aims to identify Acroporidae and Favidae as the models of coral reef-building species. The samples were collected from the waters of Beralas Pasir Island, Bintan Regency. Visual engineering was conducted in the form of 3D viewing with attention to the corallite shape and size, as well as the color of the corals. The result was successful in identifying 4 species, i.e. Acropora microphthalma, A. sarmentosa, Favia maritima, F. vietnamensis. The keys benefit of this methodologies are: •The RIKA-R3DI method allows to reduce diving time during direct visual observation.•The method has high accuracy and is non-invasive, since it does not touch directly to the coral.•The application of RIKA-R3DI can be used to identified the coral species and evaluate the coral health status base on the percent coverage.

Proliferation, Characterization and Differentiation Potency of Adipose Tissue-Derived Mesenchymal Stem Cells (AT-MSCs) Cultured in Fresh Frozen and non-Fresh Frozen Plasma.

Mesenchymal stem cells (MSCs) have unique properties, including high proliferation rates, self-renewal, and multilineage differentiation ability. Their characteristics are affected by increasing age and microenvironment. This research is aimed to determine the proliferation, characteristics and differentiation capacity of adipose tissue-derived (AT)-MSCs at many passages with different media. The cell proliferation capacity was assayed using trypan blue. MSCs characterization (CD90, CD44, CD105, CD73, CD11b, CD19, CD34, CD45, and HLA-DR) was performed by flow cytometry, and cell differentiation was determined by specific stainings. Population doubling time (PDT) of AT-MSCs treated with fresh frozen plasma (FFP) and non-FFP increased in the late passage (P) (P15 FFP was 22.67 ± 7.01 days and non-FFP was 19.65 ± 2.27 days). Cumulative cell number was significantly different between FFP and non-FFP at P5, 10, 15. AT-MSCs at P4-15 were positive for CD90, CD44, CD105, and CD73, and negative for CD11b, CD19, CD34, CD45, and HLA-DR surface markers. AT-MSCs at P5, 10, 15 had potential toward adipogenic, chondrogenic, and osteogenic differentiation. Therefore, PDT was affected by increased age but no difference was observed in morphology, surface markers and differentiation capacity among passages. Cumulative cell number in FFP was higher in comparison with non-FFP in P5, 10, 15. Our data suggest that FFP may replace FBS for culturing MSCs.