The amygdala differentially regulates defensive behaviors evoked by CO2.

CO2 inhalation can provoke panic attacks in humans, and the likelihood is increased in patients with panic disorder. Identifying brain sites involved could provide important mechanistic insight into the illness. In mice, the amygdala has been suggested to promote CO2 responses; however, recent studies in humans with amygdala damage indicate the amygdala is not required for CO2-induced fear and panic and might actually oppose these responses. To clarify the role of the amygdala, we produced lesions in mice paralleling the human lesions, and characterized behavioral responses to CO2. Compared to sham controls, we found that amygdala-lesioned mice froze less to 10% CO2, and unlike shams they also began to jump frenetically. At 20% CO2, controls also exhibited jumping, suggesting it is a normal response to more extreme CO2 concentrations. The effect of amygdala lesions was specific to CO2 as amygdala-lesioned mice did not jump in response to a predator odor or to an auditory conditioned stimulus. In amygdala-lesioned mice, jumping evoked by 10% CO2 was eliminated by co-lesioning the dorsal periaqueductal gray, a structure implicated in panic and escape-related behaviors. Together, these observations suggest a dual role for the amygdala in the CO2 response: promoting CO2-induced freezing, and opposing CO2-induced jumping, which may help explain the exaggerated CO2 responses in humans with amygdala lesions.

Complete absence of the posterior arch of C1: Case report.

Posterior atlas arch anomalies are relatively common, but have a variety of presentations ranging from partial clefts to complete agenesis of the posterior arch. Partial clefts are prevalent in 4% of patients and are generally asymptomatic. However, complete agenesis of the posterior arch is extremely rare. We report the case of a 46-year-old man who presented with upper cervical spine and occipital pain as well as left sided headaches. Imaging revealed congenital complete absence of the posterior arch of C1 (Type E) without any radiographic evidence of instability. We discuss our case in light of other reported cases and detail its management.

Radiographic and intraoperative imaging of a hemisection of the spinal cord resulting in a pure Brown-Séquard syndrome: case report and review of the literature.

Brown-Séquard plus syndrome (BSPS) or incomplete spinal cord injuries from stab injury have been widely reported. However, only four detailed cases of pure Brown-Séquard syndrome (BSS) from stab injury have been previously reported. Here we present the case of an 18-year-old man who sustained a penetrating knife stab injury to the right side of his back resulting in a pure Brown-Séquard syndrome with left lower extremity hemiplegia. Imaging revealed right-sided soft tissue and ligamentous damage traveling in a right-to-left fashion as well as left-sided T2-weighted MRI cord signal change at the level of T9. Given concern for a cerebrospinal fluid leak (CSF) leak, the patient was taken for wound exploration, irrigation, laminectomy, dural closure and lumbar drain placement. At three years follow up, the patient was almost full strength. This is the first case in the literature demonstrating radiographic and correlative intraoperative imaging of a hemisection of the spinal cord resulting in a pure Brown-Séquard syndrome.