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1.
BMC Med Genet ; 21(1): 90, 2020 05 05.
Artículo en Inglés | MEDLINE | ID: mdl-32370745

RESUMEN

BACKGROUND: ERF-related craniosynostosis are a rare, complex, premature trisutural fusion associated with a broad spectrum of clinical features and heterogeneous aetiology. Here we describe two cases with the same pathogenic variant and a detailed description of their clinical course. CASE PRESENTATION: Two subjects; a boy with a BLSS requiring repeated skull expansions and his mother who had been operated once for sagittal synostosis. Both developed intracranial hypertension at some point during the course, which was for both verified by formal invasive intracranial pressure monitoring. Exome sequencing revealed a pathogenic truncating frame shift variant in the ERF gene. CONCLUSIONS: Here we describe a boy and his mother with different craniosynostosis patterns, but both with verified intracranial hypertension and heterozygosity for a truncating variant of ERF c.1201_1202delAA (p.Lys401Glufs*10). Our work provides supplementary evidence in support of previous phenotypic descriptions of ERF-related craniosynostosis, particularly late presentation, an evolving synostotic pattern and variable expressivity even among affected family members.


Asunto(s)
Craneosinostosis/genética , Predisposición Genética a la Enfermedad , Hipertensión Intracraneal/genética , Proteínas Represoras/genética , Adulto , Craneosinostosis/complicaciones , Craneosinostosis/patología , Craneosinostosis/cirugía , Femenino , Heterocigoto , Humanos , Lactante , Hipertensión Intracraneal/complicaciones , Hipertensión Intracraneal/patología , Hipertensión Intracraneal/cirugía , Masculino , Madres , Cráneo/patología , Cráneo/cirugía
2.
Neurol Sci ; 41(2): 329-333, 2020 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-31586289

RESUMEN

BACKGROUND: Ultrasonography of the optic nerve sheath diameter (ONSD) is used for the non-invasive assessment of increased intracranial pressure (ICP). ONSD values are usually obtained by averaging the measurements of the two eyes, but asymmetric ONSD dilation is possible, leading to potentially inaccurate ICP estimation when using binocular averaging. In addition, few data are available about the asymmetry of the ONSD and the use of the maximum ONSD value between eyes for raised ICP detection. The aim of the study was to evaluate the interocular ONSD asymmetry in healthy subjects and patients with intracranial hypertension (IH) by ultrasonography and to investigate whether the maximum ONSD could be as useful as the binocular assessment. METHODS: Forty healthy subjects and 40 patients with IH (20 with idiopathic intracranial hypertension and 20 with intracerebral hemorrhage) who underwent transorbital sonography were retrospectively enrolled. The prevalence and degree of ONSD asymmetry were compared among groups; ONSD median binocular and maximum values were compared. RESULTS: Forty-two out of 80 subjects (52.5%) showed significant ONSD asymmetry, without significant differences in prevalence among groups (p = 0.28). The median asymmetry was higher in patients than in healthy subjects (0.45 mm vs 0.23 mm; p = 0.007), without significant differences between the two pathologies (p = 0.58). Both binocular and maximum ONSD measurements were significantly higher in patients with IH than in controls (p < 0.001). CONCLUSIONS: Interocular ONSD asymmetry occurs both in healthy subjects and, more consistently, in patients with IH. Both binocular and maximum ONSD may be useful markers for increased ICP detection.


Asunto(s)
Hipertensión Intracraneal/patología , Presión Intracraneal/fisiología , Nervio Óptico/patología , Seudotumor Cerebral/patología , Adulto , Anciano , Hemorragia Cerebral/patología , Ojo/patología , Femenino , Voluntarios Sanos , Humanos , Masculino , Persona de Mediana Edad
3.
Pract Neurol ; 20(1): 39-49, 2020 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-31649103

RESUMEN

The skull base is the major bony and soft tissue interface for the intracranial and extracranial compartments. Its anatomy is complex, containing multiple traversing foramina that act as conduits for various neurovascular structures. The optimum imaging modality depends on the specific diagnostic question and area of interest; both CT and MR have complementary roles. This article focuses on the applied compartmental anatomy of the skull base and specific imaging protocols, and discusses the range of pathologies that neurologists will encounter.


Asunto(s)
Imagen por Resonancia Magnética/métodos , Base del Cráneo/anatomía & histología , Base del Cráneo/diagnóstico por imagen , Tomografía Computarizada por Rayos X/métodos , Humanos , Hipertensión Intracraneal/diagnóstico por imagen , Hipertensión Intracraneal/patología , Base del Cráneo/patología , Neoplasias de la Base del Cráneo/diagnóstico por imagen , Neoplasias de la Base del Cráneo/patología , Acúfeno/diagnóstico por imagen , Acúfeno/patología
4.
Neurosciences (Riyadh) ; 24(4): 257-263, 2019 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-31872803

RESUMEN

OBJECTIVE: To review the experience of 2 tertiary centers in Saudi Arabia with intracranial hypertension (IH) in the pediatric population. METHODS: We retrospectively reviewed and analyzed pediatric patients diagnosed with IH from June 2002 to May 2017 in 2 institutes. RESULTS: We identified 53 patients (30 females and 23 males) with a mean age of 7 years at the time of presentation. Among them, 41 patients were younger than 12 years, and 12 were older. Obese and overweight patients constituted 27.00% (n = 14) of all cases, 8 (66.7%) of whom were older than 12 years. The most common presenting feature was papilledema followed by headache. Vitamin D deficiency, which constituted the most common associated condition, was identified in 12 (22.6%) patients. Acetazolamide was the treatment option in 98.11% of patients, and only 5.7% underwent surgical interventions. The length of follow-up ranged from 6 months to 8 years. CONCLUSION: Intracranial hypertension is rare in children and commonly seen in overweight females older than 12 years similar to adults. Patients younger than 12 years tend to develop secondary IH. More studies are needed to characterize the clinical presentation and guide the management plan.


Asunto(s)
Cefalea/epidemiología , Hipertensión Intracraneal/complicaciones , Obesidad/epidemiología , Papiledema/epidemiología , Deficiencia de Vitamina D/epidemiología , Acetazolamida/uso terapéutico , Niño , Preescolar , Diuréticos/uso terapéutico , Femenino , Hospitales Pediátricos/estadística & datos numéricos , Humanos , Lactante , Hipertensión Intracraneal/tratamiento farmacológico , Hipertensión Intracraneal/epidemiología , Hipertensión Intracraneal/patología , Masculino , Arabia Saudita , Centros de Atención Terciaria/estadística & datos numéricos
5.
Eur J Radiol ; 120: 108644, 2019 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-31539793

RESUMEN

PURPOSE: Transverse sinus stenosis (TSS) is the most sensitive imaging characteristic of idiopathic intracranial hypertension (IIH). This study aimed to assess the diagnostic performance of contrast-enhanced magnetic resonance high-resolution variable flip angle turbo-spin-echo (T1 SPACE) technique in TSS patients and evaluate the diagnostic accuracy of enhanced T1 SPACE, and phase-contrast magnetic resonance venography (PC MRV) with digital subtraction angiography (DSA) as standard imaging. METHOD: This prospective study enrolled 62 patients with suspected IIH and PC MRV-confirmed transverse sinus stenosis. All patients underwent lumbar puncture, PC MRV, enhanced T1 SPACE sequences and DSA examination. The accuracy, sensitivity, and specificity of enhanced T1 SPACE in detecting venous sinus stenosis were calculated and compared with those of PC MRV. Intermodality agreement (Kendall's rank correlation coefficients and weighted kappa statistic) was assessed. RESULTS: Sixty-two patients were enrolled from November 2016 to October 2018. For the measured stenosis, better correlation was observed in enhanced T1 SPACE and DSA (AUC = 0.953) than PC MRV (AUC = 0.871). Intermodality agreement of enhanced T1 SPACE (rk = 0.895 and weighted ĸ = 0.868) was better than PC MRV (rk = 0.753 and weighted ĸ = 0.653) compared with DSA. Thirty-seven intrasinus filling defects were detected by contrast-enhanced T1 SPACE, while only twenty of them were detected on source imaging of PC MRV. CONCLUSIONS: The contrast-enhanced T1 SPACE sequence was more sensitive and specific compared with PC MRV in assessing stenosis and detecting lesions in TSS patients. Accurate determination of the presence and extent of TSS using this technique might be useful in patient selection and guiding the treatment.


Asunto(s)
Hipertensión Intracraneal/patología , Senos Transversos/patología , Adulto , Anciano , Angiografía de Substracción Digital/métodos , Constricción Patológica/patología , Femenino , Humanos , Angiografía por Resonancia Magnética/métodos , Masculino , Flebografía/métodos , Estudios Prospectivos , Sensibilidad y Especificidad
7.
World Neurosurg ; 129: e63-e72, 2019 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-31100532

RESUMEN

OBJECTIVE: Early brain injury after subarachnoid hemorrhage (SAH), which is considered a main factor leading to poor outcome, is believed to be caused by the increase of intracranial pressure (ICP) and/or the presence of subarachnoid blood clots (SBC) itself. The purpose of this study was to examine whether ICP or SBC is more important to neurologic deficit in the presence of apoptosis or edema. METHODS: A total of 50 rats were allocated to 3 groups: an endovascular perforation SAH model (the SAH group), a cisterna magna saline injection model (the saline injection group), and a cisterna magna sham injection model (the sham injection group). Statistical analysis of correlations among the ICP, the grade of clot volume, neuronal apoptosis, brain water content (brain edema), and neurologic deficit was performed. RESULTS: In the SAH group, each of increased ICP and clot volume was correlated with neuronal apoptosis and brain edema. In the saline injection group, increased ICP was associated with apoptosis, but it did not correlate with brain edema. Neuronal apoptosis (r = 0.75; P < 0.01) and brain edema (r = 0.89; P < 0.01) correlated independently with neurologic deficit in the SAH group. CONCLUSIONS: The present study suggests that neuronal apoptosis is caused mainly by increased ICP, whereas brain edema is induced by SBC, and increased ICP could aggravate it in the presence of SBC. Brain edema could affect neurologic deficit, but apoptosis alone may be less influential. Not only ICP but also SBC seem important for brain damage in the acute stage of SAH.


Asunto(s)
Edema Encefálico/etiología , Lesiones Encefálicas/etiología , Hipertensión Intracraneal/complicaciones , Hemorragia Subaracnoidea/complicaciones , Trombosis/complicaciones , Animales , Apoptosis/fisiología , Edema Encefálico/patología , Lesiones Encefálicas/patología , Hipertensión Intracraneal/patología , Masculino , Ratas , Ratas Sprague-Dawley , Hemorragia Subaracnoidea/patología , Trombosis/patología
8.
Acta Neurochir (Wien) ; 161(7): 1367-1370, 2019 07.
Artículo en Inglés | MEDLINE | ID: mdl-31025176

RESUMEN

Patients with idiopathic intracranial hypertension are frequently obese women with normal/slit ventricles. Patients with high-pressure hydrocephalus, instead, present enlarged ventricles. We describe a 63-year-old woman with signs and symptoms of intracranial hypertension. Brain MRI revealed hydrocephalus. Venous Doppler ultrasound showed external compression of the omohyoid muscles on the internal jugular veins. During jugular vein decompression, intracranial pressure dropped from 18 to 6 mmHg. Patient is asymptomatic at 2-year follow-up, with decreased brain ventricles. These findings could represent a novel form of high-pressure hydrocephalus that can be successfully treated without a CSF shunt. We called this syndrome JEDI (jugular entrapment dilated ventricles intracranial hypertension).


Asunto(s)
Hidrocefalia/diagnóstico por imagen , Hipertensión Intracraneal/diagnóstico por imagen , Seudotumor Cerebral/diagnóstico por imagen , Ventrículos Cerebrales/diagnóstico por imagen , Femenino , Humanos , Hidrocefalia/patología , Hipertensión Intracraneal/patología , Venas Yugulares/diagnóstico por imagen , Imagen por Resonancia Magnética , Persona de Mediana Edad , Seudotumor Cerebral/patología , Síndrome , Ultrasonografía Doppler Transcraneal
10.
Oper Neurosurg (Hagerstown) ; 16(6): 726-733, 2019 06 01.
Artículo en Inglés | MEDLINE | ID: mdl-30169680

RESUMEN

BACKGROUND: Measurement of optic nerve sheath diameter (ONSD) is a promising technique for noninvasive assessment of intracranial pressure (ICP), but has certain limitations. A recent study showed that the deformability index (DI), a dynamic parameter quantifying the pulsatile nature of the optic nerve sheath, could differentiate between patients with high vs normal ICP. OBJECTIVE: To further evaluate the diagnostic accuracy of the DI, when interpreted together with ONSD. METHODS: This prospective study included children undergoing invasive ICP measurement as part of their clinical management. Ultrasound images of the optic nerve sheath were acquired prior to measuring ICP, the images were further processed to obtain the DI. Patients were dichotomized into high (≥20 mm Hg) or normal ICP groups and compared using the Mann-Whitney U-test. Diagnostic accuracy was described using area under the receiver operating characteristic curve (AUC), sensitivity and specificity, correlation between DI, ONSD, and ICP was investigated using linear regression. RESULTS: A total of 28 patients were included (19 high ICP). The DI was lower in the high ICP group (0.105 vs 0.28, P = .001). AUC was 0.87, and a cut-off value of DI ≤ 0.185 demonstrated sensitivity of 89.5% and specificity of 88.9%. Diagnostic accuracy improved when combining DI with ONSD (AUC 0.98, sensitivity 94.7%, specificity 88.9%) and correlation with ICP improved when combined analysis of DI and ONSD was performed (Pearson correlation coefficient: 0.82 vs 0.42, respectively, P = .012). CONCLUSION: The DI was significantly lower for patients with high vs normal ICP. This relationship improved further when the DI and ONSD were interpreted together.


Asunto(s)
Hipertensión Intracraneal/diagnóstico por imagen , Presión Intracraneal , Vaina de Mielina/patología , Nervio Óptico/diagnóstico por imagen , Ultrasonografía/métodos , Lesiones Traumáticas del Encéfalo/complicaciones , Neoplasias del Ventrículo Cerebral/complicaciones , Niño , Preescolar , Craneosinostosis/complicaciones , Femenino , Humanos , Hidrocefalia/complicaciones , Lactante , Hipertensión Intracraneal/etiología , Hipertensión Intracraneal/patología , Masculino , Monitoreo Fisiológico , Vaina de Mielina/fisiología , Nervio Óptico/patología , Nervio Óptico/fisiopatología , Órbita , Tamaño de los Órganos , Estudios Prospectivos
12.
Neuro Endocrinol Lett ; 39(3): 209-218, 2018 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-30431738

RESUMEN

OBJECTIVES: This paper presents our own rat model of the cellular brain edema, induced by water intoxication (WI). The basic principle of the model is an osmotic imbalance in the cell membrane followed by an intracellular flow of sodium and simultaneous accumulation of water leading to the subsequent increase of BBB permeability. METHODS: The usefulness of the model was tested in precisely specified conditions whose results were clearly expressed. The procedure determined both how WI induces cellular edema as well as the disturbances caused by cellular edema. RESULTS: The evidence of existing cellular edema with increased BBB permeability was proved by intracellular accumulation of intravital dye with a large molecular size; increased brain-water content was confirmed by using the dry/wet weight method and by the decrease in CT density; the elevated intracranial pressure (ICP) due to the expanding volume was determined by continuous monitoring the ICP; the structural lesions were proved by identification of the myelin disintegration; and the impaired nervous functions was demonstrated by the of open field test method. CONCLUSION: Our experimental model can help the future studies of pathophysiology of cellular brain edema and is suitable for testing neuroprotective agents.


Asunto(s)
Conducta Animal , Edema Encefálico/fisiopatología , Modelos Animales de Enfermedad , Hipertensión Intracraneal/fisiopatología , Locomoción , Ratas , Intoxicación por Agua/fisiopatología , Animales , Barrera Hematoencefálica/metabolismo , Encéfalo/diagnóstico por imagen , Encéfalo/metabolismo , Encéfalo/patología , Edema Encefálico/etiología , Edema Encefálico/metabolismo , Edema Encefálico/patología , Azul de Evans , Hipertensión Intracraneal/etiología , Hipertensión Intracraneal/metabolismo , Hipertensión Intracraneal/patología , Masculino , Vaina de Mielina/patología , Permeabilidad , Ratas Wistar , Tomografía Computarizada por Rayos X , Intoxicación por Agua/complicaciones , Intoxicación por Agua/metabolismo , Intoxicación por Agua/patología
13.
J Clin Neurosci ; 58: 192-199, 2018 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-30454689

RESUMEN

Cerebral edema leading to elevated intracranial pressure (ICP) is a fundamental concern after severe traumatic brain injury (TBI), stroke, and severe acute hyponatremia. We describe a swine model of water intoxication and its cerebral histological and physiological sequela. We studied female swine weighing 35-45 kg. Four serum sodium intervals were designated: baseline, mild, moderate, and severe hyponatremia attained by infusing hypotonic saline. Intracranial fluid injections were performed to assess intracranial compliance. At baseline and following water intoxication wedge biopsy was obtained for pathological examination and electron microscopy. We studied 8 swine and found an increase in ICP that was strongly related to the decrease in serum sodium level. Mean ICP rose from a baseline of 6 ±â€¯2 to 28 ±â€¯6 mm Hg during severe hyponatremia, while cerebral perfusion pressure (CPP) decreased from 72 ±â€¯10 to 46 ±â€¯11 mm Hg. Brain tissue oxygen tension (PbtO2) decreased from 18.4 ±â€¯8.9 to 5.3 ±â€¯3.0 mm Hg. Electron microscopy demonstrated intracellular edema and astrocytic foot process swelling following water intoxication. With severe hyponatremia, 2 cc intracranial fluid injection resulted in progressively greater ICP dose, indicating a worsening intracranial compliance. Our model leads to graded and sustained elevation of ICP, lower CPP, and decreased PbtO2, all of which cross clinically relevant thresholds. Intracranial compliance worsens with increased cerebral swelling. This model may serve as a platform to study which therapeutic interventions best improve the cerebral physiological profile in the face of severe brain edema.


Asunto(s)
Edema Encefálico/fisiopatología , Modelos Animales de Enfermedad , Líquido Intracelular/fisiología , Hipertensión Intracraneal/fisiopatología , Presión Intracraneal/fisiología , Animales , Encéfalo/patología , Encéfalo/fisiopatología , Encéfalo/ultraestructura , Edema Encefálico/patología , Circulación Cerebrovascular/fisiología , Citoplasma/patología , Citoplasma/fisiología , Femenino , Humanos , Hiponatremia/patología , Hiponatremia/fisiopatología , Hipertensión Intracraneal/patología , Porcinos
14.
BMC Cancer ; 18(1): 871, 2018 Sep 03.
Artículo en Inglés | MEDLINE | ID: mdl-30176837

RESUMEN

BACKGROUND: Although our previous study revealed lumbar punctured resveratrol could remarkably prolong the survival of rats bearing orthotopic glioblastomas, it also suggested the administration did not completely suppress rapid tumour growth. These evidences led us to consider that the prognosis of tumour-bearing rats may be further improved if this treatment is used in combination with neurosurgery. Therefore, we investigated the effectiveness of the combined treatment on rat orthotopic glioblastomas. METHODS: Rat RG2 glioblastoma cells were inoculated into the brains of 36 rats. The rats were subjected to partial tumour removal after they showed symptoms of intracranial hypertension. There were 28 rats that survived the surgery, and these animals were randomly and equally divided into the control group without postoperative treatment and the LP group treated with 100 µl of 300 µM resveratrol via the LP route. Resveratrol was administered 24 h after tumour resection in 3-day intervals, and the animals received 7 treatments. The intracranial tumour sizes, average life span, cell apoptosis and STAT3 signalling were evaluated by multiple experimental approaches in the tumour tissues harvested from both groups. RESULTS: The results showed that 5 of the 14 (35.7%) rats in the LP group remained alive over 60 days without any sign of recurrence. The remaining nine animals had a longer mean postoperative survival time (11.0 ± 2.9 days) than that of the (7.3 + 1.3 days; p < 0.05) control group. The resveratrol-treated tumour tissues showed less Ki67 labelling, widely distributed apoptotic regions, upregulated PIAS3 expression and reduced p-STAT3 nuclear translocation. CONCLUSIONS: This study demonstrates that postoperative resveratrol administration efficiently improves the prognosis of rat advanced orthotopic glioblastoma via inhibition of growth, induction of apoptosis and inactivation of STAT3 signalling. Therefore, this therapeutic approach could be of potential practical value in the management of glioblastomas.


Asunto(s)
Glioblastoma/tratamiento farmacológico , Hipertensión Intracraneal/tratamiento farmacológico , Recurrencia Local de Neoplasia/tratamiento farmacológico , Factor de Transcripción STAT3/genética , Animales , Apoptosis/efectos de los fármacos , Proliferación Celular/efectos de los fármacos , Modelos Animales de Enfermedad , Regulación Neoplásica de la Expresión Génica/efectos de los fármacos , Glioblastoma/complicaciones , Glioblastoma/patología , Glioblastoma/cirugía , Humanos , Hipertensión Intracraneal/etiología , Hipertensión Intracraneal/genética , Hipertensión Intracraneal/patología , Recurrencia Local de Neoplasia/genética , Recurrencia Local de Neoplasia/patología , Pronóstico , Ratas , Resveratrol , Transducción de Señal/efectos de los fármacos , Estilbenos/administración & dosificación , Estilbenos/efectos adversos
15.
Am J Physiol Cell Physiol ; 315(6): C839-C849, 2018 12 01.
Artículo en Inglés | MEDLINE | ID: mdl-30183321

RESUMEN

Glaucoma represents a major cause of blindness, generally associated with elevated intraocular pressure (EIOP). The aim of the present study was to investigate whether microRNA-149 (miR-149) affects retinal ganglion cells (RGCs) and the underlying mechanism based on a mouse model of chronic glaucoma with EIOP. The successfully modeled mice were administered with mimics or inhibitors of miR-149. Next, the number of RGCs, ultrastructural changes of RGCs, and purity of RGCs in the retinal tissues were detected. Moreover, the RGCs were collected and subsequently treated with 60 mmHg pressure and transfected with a series of plasmids aiding in the regulation of the expression of miR-149 and betacellulin (BTC). The levels of miR-149, BTC, phosphatidylinositol 3-kinase (PI3K), and Akt were subsequently determined. Finally, RGC viability and apoptosis were detected accordingly. Dual luciferase reporter gene assay provided validation, highlighting BTC was indeed a target gene of miR-149. The downregulation of miR-149 is accompanied by an increased number of RGCs and decreased ultrastructural RGC alterations. Additionally, downregulated miR-149 was noted to increase the levels of BTC, PI3K, and Akt in both the retinal tissues and RGCs, whereas the silencing of miR-149 was observed to promote the viability of RGC and inhibit RGC apoptosis. Taken together, the results of the current study provided validation suggesting that the downregulation of miR-149 confers protection to RGCs by means of activating the PI3K/Akt signaling pathway via upregulation of BTC in mice with glaucoma. Evidence presented indicated the promise of miR-149 inhibition as a potential therapeutic strategy for glaucoma treatment.


Asunto(s)
Apoptosis/genética , Betacelulina/genética , Glaucoma/genética , MicroARNs/genética , Animales , Supervivencia Celular/genética , Modelos Animales de Enfermedad , Regulación de la Expresión Génica , Glaucoma/patología , Humanos , Hipertensión Intracraneal/genética , Hipertensión Intracraneal/patología , Ratones , Proteína Oncogénica v-akt/genética , Fosfatidilinositol 3-Quinasas/genética , Células Ganglionares de la Retina/metabolismo , Células Ganglionares de la Retina/patología , Transducción de Señal/genética
16.
Neurol Res ; 40(9): 728-735, 2018 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-29799769

RESUMEN

BACKGROUND: Early diagnosis and proper monitoring of intracranial pressure (ICP) in idiopathic intracranial hypertension (IIH) could reduce morbidity. OBJECTIVES: The objective was to explore and monitor reflection of raised ICP in IIH on optic nerve sheath diameter (ONSD), papillary height and ophthalmic vessels hemodynamics, using transorbital sonography (TOS). METHODS: The study included 24 IIH patients and 30 controls. Patients were compared to controls (phase I) then reassessed twice; 1 week and 4 weeks later (phase II). Both groups underwent clinical evaluation and TOS to measure ONSD, papillary elevation, and color Doppler indices of the ophthalmic vessels. Patients underwent lumbar puncture (LP) to measure cerebrospinal fluid (CSF) pressure. RESULTS: ONSD was significantly higher in patients compared to controls (p < 0.001). The cut-off value was 6.2 mm. Papillary elevation (p = 0.006) and ONSD (p = 0.006) were significantly reduced 4 weeks following LP. Baseline color Doppler indices of the ophthalmic vessels were comparable between both groups and the changes observed during the follow-up visits in the patients were insignificant. CONCLUSION: Reflected ICP changes on ONSD and papilla, measured by TOS, could be a valuable noninvasive additional tool to diagnose and monitor IIH patients. IIH insignificantly influences ophthalmic vessels hemodynamics. Abbreviation BMI: Body mass index. CSF: Cerebrospinal fluid. EDV: End diastolic velocity. ICP: Intracranial pressure. IH:intracranial hypertension. IIH: Idiopathic intracranial hypertension. LP: Lumbar puncture. MI: Mechanical index. MRI: Magnetic resonance imaging. MRV: Magnetic resonance venography. OA: Ophthalmic artery OND: Optic nerve diameter. ONSD: Optic nerve sheath diameter. OV: Ophthalmic vein. PIs: Pulsatility indices. PSV: Peak systolic velocity. ROC: Receiver operator characteristic. TOS: Trans-orbital sonography.


Asunto(s)
Ojo/irrigación sanguínea , Ojo/diagnóstico por imagen , Hipertensión Intracraneal/diagnóstico por imagen , Nervio Óptico/diagnóstico por imagen , Ultrasonografía Doppler en Color , Adulto , Estudios de Casos y Controles , Femenino , Estudios de Seguimiento , Hemodinámica , Humanos , Hipertensión Intracraneal/patología , Presión Intracraneal , Persona de Mediana Edad , Nervio Óptico/patología , Tamaño de los Órganos , Estudios Prospectivos , Punción Espinal , Adulto Joven
17.
Acta Neurochir Suppl ; 126: 309-312, 2018.
Artículo en Inglés | MEDLINE | ID: mdl-29492580

RESUMEN

OBJECTIVE: In previous work we showed that high intracranial pressure (ICP) in the rat brain induces a transition from capillary (CAP) to pathological microvascular shunt (MVS) flow, resulting in brain hypoxia, edema, and blood-brain barrier (BBB) damage. This transition was correlated with a loss of cerebral blood flow (CBF) autoregulation undetected by static autoregulatory curves but identified by induced dynamic ICP (iPRx) and cerebrovascular (iCVRx) reactivity. We hypothesized that loss of CBF autoregulation as correlated with MVS flow would be identified by iPRx and iCVRx in traumatic brain injury (TBI) with elevated ICP. METHODS: TBI was induced by lateral fluid percussion (LFP) using a gas-driven device in rats. Using in vivo two-photon laser scanning microscopy, cortical microcirculation, tissue oxygenation (NADH autofluoresence), and BBB permeability (fluorescein dye extravasation) were measured before and for 4 h after TBI. Laser Doppler cortical flux, rectal and brain temperature, ICP and mean arterial pressure (MAP), blood gases, and electrolytes were monitored. Every 30 min, a transient 10 mmHg rise in MAP was induced by i.v. bolus of dopamine. iPRx = ΔICP/ΔMAP and iCVRx = ΔCBF/ΔMAP. RESULTS: We demonstrated that iPRx and iCVRx correctly identified more severe loss of CBF autoregulation correlated with a transition of blood flow to MVS after TBI with high ICP compared to TBI without an increase in ICP. CONCLUSIONS: In TBI with high ICP, high-velocity MVS flow is responsible for the loss of CBF autoregulation identified by iPRx and iCVRx.


Asunto(s)
Lesiones Traumáticas del Encéfalo/fisiopatología , Corteza Cerebral/fisiopatología , Circulación Cerebrovascular/fisiología , Homeostasis/fisiología , Hipertensión Intracraneal/fisiopatología , Microcirculación/fisiología , Animales , Barrera Hematoencefálica/metabolismo , Lesiones Traumáticas del Encéfalo/metabolismo , Lesiones Traumáticas del Encéfalo/patología , Corteza Cerebral/irrigación sanguínea , Corteza Cerebral/patología , Hipertensión Intracraneal/metabolismo , Hipertensión Intracraneal/patología , Presión Intracraneal , Microscopía Intravital , Masculino , Microscopía Confocal , Permeabilidad , Ratas , Ratas Sprague-Dawley
18.
Clin Neurol Neurosurg ; 167: 31-35, 2018 04.
Artículo en Inglés | MEDLINE | ID: mdl-29433056

RESUMEN

OBJECTIVE: The usefulness of optic nerve sheath diameter (ONSD) in predicting increased intracranial pressure (ICP) is not well established in adults with hydrocephalus. In this retrospective study, we evaluated the correlation between ONSD measured on brain computed tomography (CT) and ICP in adults with hydrocephalus. PATIENTS AND METHODS: ONSDs were measured on preoperative brain CT images from 64 adult patients with hydrocephalus who underwent extracranial ventricular drainage or a ventriculoperitoneal shunt in 2016. ICP was defined as ventricular fluid pressure. RESULTS: The ONSD measured on preoperative CT was greater in patients (n = 8) with a higher ICP (>20 mmHg, 5.8vs. 4.9 mm, P = 0.001). The ONSD was linearly correlated with ICP (r = 0.543, P < 0.001) and was predictive of increased ICP with an area under the receiver operating characteristic curve of 0.834. The optimal cut-off value of 5.3 mm ONSD yielded 88% sensitivity and 79% specificity. The inter-class coefficient of ONSD on preoperative CT was 0.882. The correlation between ONSD on preoperative CT and ICP was detected only in patients with communicating and non-communicating hydrocephalus (r = 0.437 and r = 0.585, P = 0.037 and P = 0.002, respectively). CONCLUSION: ONSD measured on preoperative brain CT was linearly correlated with ICP in adult patients with communicating and non-communicating hydrocephalus, and it was a predictor of increased ICP with good discrimination and high inter-observer reliability. These results suggest that preoperative ONSD measurement on brain CT can be helpful to safely manage such patients by providing information about ICP.


Asunto(s)
Hidrocefalia/cirugía , Hipertensión Intracraneal/patología , Presión Intracraneal/fisiología , Nervio Óptico/patología , Tomografía Computarizada por Rayos X , Adulto , Anciano , Encéfalo/cirugía , Femenino , Humanos , Hipertensión Intracraneal/fisiopatología , Masculino , Persona de Mediana Edad , Neuroimagen/métodos , Nervio Óptico/fisiopatología , Curva ROC , Reproducibilidad de los Resultados , Tomografía Computarizada por Rayos X/métodos
19.
Methods Mol Biol ; 1717: 37-52, 2018.
Artículo en Inglés | MEDLINE | ID: mdl-29468582

RESUMEN

Traumatic brain injury (TBI) is one of the leading causes of death and disability worldwide. It is a silently growing epidemic with multifaceted pathogenesis, and current standards of treatments aim to target only the symptoms of the primary injury, while there is a tremendous need to explore interventions that can halt the progression of the secondary injuries. The use of a reliable animal model to study and understand the various aspects the pathobiology of TBI is extremely important in therapeutic drug development against TBI-associated complications. The controlled cortical impact (CCI) model of TBI described here, uses a mechanical impactor to inflict a mechanical injury into the mouse brain. This method is a reliable and reproducible approach to inflict mild, moderate or severe injuries to the animal for studying TBI-associated blood-brain barrier (BBB) dysfunctions, neuronal injuries, brain edema, neurobehavioral changes, etc. The present method describes how the CCI model could be utilized for determining the BBB dysfunction and hyperpermeability associated with TBI. Blood-brain barrier disruption is a hallmark feature of the secondary injury that occur following TBI, frequently associated with leakage of fluid and proteins into the extravascular space leading to vasogenic edema and elevation of intracranial pressure. The method described here focuses on the development of a CCI-based mouse model of TBI followed by the evaluation of BBB integrity and permeability by intravital microscopy as well as Evans Blue extravasation assay.


Asunto(s)
Barrera Hematoencefálica , Lesiones Traumáticas del Encéfalo , Hipertensión Intracraneal , Animales , Barrera Hematoencefálica/metabolismo , Barrera Hematoencefálica/patología , Barrera Hematoencefálica/fisiopatología , Lesiones Traumáticas del Encéfalo/metabolismo , Lesiones Traumáticas del Encéfalo/patología , Lesiones Traumáticas del Encéfalo/fisiopatología , Modelos Animales de Enfermedad , Humanos , Hipertensión Intracraneal/metabolismo , Hipertensión Intracraneal/patología , Hipertensión Intracraneal/fisiopatología , Ratones
20.
Neuroradiology ; 60(4): 365-372, 2018 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-29417173

RESUMEN

PURPOSE: This aimed to evaluate the prevalence and extent of bilateral sigmoid sinus dehiscence (SSD) and to explore the presence of idiopathic intracranial hypertension (IIH) in patients with unilateral pulsatile tinnitus (PT) with CTA/V. METHODS: Sixty PT patients (52 females; 40.4 ± 11.6 years [20-72]) who underwent CTA/V and 30 non-PT patients (27 females; 38.4 ± 14.7 years [12-62]) were enrolled in this study. The primary outcome measure was the radiographic presence of SSD. The index of transverse sinus stenosis (ITSS) was obtained by multiplying the stenosis scale values for each transverse sinus, and once was ≥ 4, the presence of IIH was suspected. RESULTS: The prevalence and extent of SSD on symptomatic side (78%; maximum transverse diameter, MTD 0.49 ± 0.23; maximum vertical diameter, MVD 0.50 ± 0.26 cm) were significantly higher and larger than those on asymptomatic side (50%, P < 0.001; MTD 0.35 ± 0.18, P = 0.006; MVD 0.30 ± 0.15 cm, P < 0.001) in the study group and those (20%, P < 0.001; MTD 0.36 ± 0.18, P = 0.073; MVD 0.30 ± 0.22 cm, P < 0.048) in the control group. The presence of SSD showed significant correlation with both PT (logistic regression analysis, OR 4.167 [1.450-11.97]; P = 0.008) and suspected IIH (OR 16.25 [1.893-139.5]; P = 0.011). CONCLUSION: In PT patients, SSD has a significant correlation with PT and a potential correlation with IIH.


Asunto(s)
Senos Craneales/diagnóstico por imagen , Hipertensión Intracraneal/diagnóstico por imagen , Acúfeno/diagnóstico por imagen , Tomografía Computarizada por Rayos X/métodos , Adolescente , Adulto , Anciano , Estudios de Casos y Controles , Niño , Constricción Patológica/complicaciones , Medios de Contraste , Senos Craneales/patología , Femenino , Humanos , Hipertensión Intracraneal/complicaciones , Hipertensión Intracraneal/patología , Yopamidol , Masculino , Persona de Mediana Edad , Prevalencia , Interpretación de Imagen Radiográfica Asistida por Computador , Estudios Retrospectivos , Acúfeno/complicaciones , Acúfeno/patología
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