Carpal tunnel syndrome related to rheumatic disease (Review).

Carpal tunnel syndrome (CTS) is the most commonly occurring type of entrapment neuropathy in the world. Several conditions may contribute to the development of CTS, such as obesity, repetitive wrist movements, pregnancy, genetic predisposition and rheumatoid arthritis (RA) inflammation. CTS is characterized by a wide range of pathophysiological factors, including increased pressure, mechanical trauma and ischemic damage to the median nerve that runs through the wrist tunnel. In the present narrative literature review, the way rheumatic diseases (RDs) contribute to CTS occurrence is investigated. The epidemiological, clinical, paraclinical and pathogenesis aspects of the relationship are examined. CTS is the most common neurological finding in RA, and incidences of RA, psoriatic arthritis and CTS are closely related. The association of CTS with systemic lupus erythematosus, Sjögren's syndrome, Behcet's disease and systemic sclerosis is weaker. In these cases, the prevalence of CTS is similar to that in the general population. As the occurrence of CTS is increasing, understanding the common mechanism and making an early diagnosis are required to limit pain and costs. When patients with RD present with symptoms such as wrist pain, tingling sensations or numbness in their fingers, CTS should be suspected. This suspicion should not be interpreted in terms of RD. To accurately evaluate patients with RD, a detailed electrophysiological examination should be included in the evaluation process. A diagnostic algorithm should include neuromuscular ultrasound or magnetic resonance imaging for patients with RD.

The "polymorphous" history of a polymorphous skull bone: the sphenoid.

For a long time, because of its location at the skull base level, the sphenoid bone was rather mysterious as it was too difficult for anatomists to reach and to elucidate its true configuration. The configuration of the sphenoid bone led to confusion regarding its sutures with the other skull bones, its shape, its detailed anatomy, and the vascular and nervous structures that cross it. This article takes the reader on a journey through time and space, charting the evolution of anatomists' comprehension of sphenoid bone morphology from antiquity to its conception as a bone structure in the eighteenth century, and ranging from ancient Greece to modern Italy and France. The journey illustrates that many anatomists have attempted to name and to best describe the structural elements of this polymorphous bone.

A possible case of Erdheim-Chester Disease.

Aim: To present the case of a 57-year-old male with progressive bilateral proptosis. Material and method: The patient presented with bilateral proptosis and strength deficiency on the upper limbs. During hospitalization, the progression was unfavorable; proptosis progressed, causing a severe loss of vision in the left eye (from 0.8 Snellen to NLP). Results: The imagistic investigation revealed bilateral infiltration of the orbits, infiltrative lesions to the mediastinum and the abdomen. The patient was referred to neurosurgery for further management. Surgical orbital decompression was performed with biopsy. The histopathological examination revealed non-Hodgkin small cell lymphoma. Conclusions: Assembling the clinical and paraclinical data we have suspected the possible diagnosis of Erdheim-Chester disease, however, positive diagnosis has not been achieved.

An entire universe of the Roman world's architecture found in the human skull.

Today's neuroanatomical terminology has its origins in the Romans' way of life, in their civil and military house architecture, as well as in the fields of engineering and technology. Despite the fact that they did not know how the nervous system worked and what the role of each neuroanatomic structure was, over time, especially in Renaissance and early modern times, the anatomists sought descriptive names for the nervous structures they have identified by way of similarity with some ancient items. This study aims to briefly review the influence of Roman architecture, engineering, and technology on neuroanatomic nomenclature, the precursor of modern neuroanatomical terminology.

NEUROPSYCHOLOGICAL GROUNDS IN THE AWAKE BRAIN SURGERY.

Traditionally, the awake cerebral neurosurgical interventions are carried out when the primary motor areas and the areas involved in language are concerned. This procedure is also known as mapping (Intraoperative Brain Mapping). The intraoperative neuropsychological protocol supposes the setting of a list of steps and tasks that the patient must perform during the surgery, taking into account the lesion localization (both the cortical and the subcortical structures), the cognitive functions involved and the individual particularities of each patient. As a result of the high validity of certain tests, we propose a common minimal set of tests, which can allow a minimal standardization and replicability.

An unwritten anatomy lesson: The influence of Roman clothing on neuroanatomical terminology: In memoriam Albert L. Rhoton, Jr. (1932-2016).

Throughout the centuries, anatomists attempting to denominate the new structures they discovered have found inspiration in the civilization of ancient Rome and the clothing worn by its citizens. This aricle presents the origins of seven neuroanatomical terms, fimbria, velum, funiculus, lemniscus, corona, splenium, and cingulum, inspired by the clothing and jewellery of Roman women and the military attire of Roman soldiers. Thus, through their apparel, the Romans influenced the Terminologia Anatomica and "clothed" the structures of the brain and spinal cord, making them immortal. Clin. Anat. 29:685-690, 2016. © 2016 Wiley Periodicals, Inc.

A review of analogies between some neuroanatomical terms and roman household objects.

Wishing to contribute to an easier remembrance of the name, shape, location and function of some neuroanatomical structures, this paper aims to identify the origin of eight Latin terms (pulvinar, capsula, infundibulum, operculum, flocculus, forceps, falx, habenula). Therefore, we analyzed the etymology of these Latin neuroanatomical terms in brief, and searched the possible correlations between the shape of different household objects used in Roman Antiquity and the shape of neuroanatomical structures bearing those names. We also perused the literature to identify the first anatomist who made such an analogy when searching to give a name to the anatomical structure he had discovered at dissection, as well as the time context of his discovery. We found knowledge of few neuroanatomical structures tracing their origin to Antiquity, but most of the nervous structures we have studied were discovered in the 19th century, when the German school of anatomy played a distinctive part. However, the multitude of Latin words designating neuroanatomical structures by analogy is an undeniable proof of neuroanatomists' amazing imagination.

A retrospective, multi-center cohort study evaluating the severity- related effects of cerebrolysin treatment on clinical outcomes in traumatic brain injury.

Traumatic brain injury (TBI) is a leading cause of death and disability for which there is currently no effective drug therapy available. Because drugs targeting a single TBI pathological pathway have failed to show clinical efficacy to date, pleiotropic agents with effects on multiple mechanisms of secondary brain damage could represent an effective option to improve brain recovery and clinical outcome in TBI patients. In this multicenter retrospective study, we investigated severity-related efficacy and safety of the add-on therapy with two concentrations (20 ml/day or 30 ml/day) of Cerebrolysin (EVER Neuro Pharma, Austria) in TBI patients. Adjunctive treatment with Cerrebrolysin started within 48 hours after TBI and clinical outcomes were ranked according to the Glasgow Outcome Scale and the Modified Rankin Disability Score at 10 and 30 days post-TBI. Analyses of efficacy were performed separately for subgroups of patients with mild, moderate or severe TBI according to Glasgow Coma Scale scores at admission. Compared to standard medical care alone (control group), both doses of Cerebrolysin were associated with improved clinical outcome scores at 10 days post-TBI in mild patients and at 10 and 30 days in moderate and severe cases. A dose-dependent effect of Cerebrolysin on TBI recovery was supported by the dose-related differences and the significant correlations with treatment duration observed for outcome measures. The safety and tolerability of Cerebrolysin in TBI patients was very good. In conclusion, the results of this large retrospective study revealed that early Cerebrolysin treatment is safe and is associated to improved TBI outcome.

Intraorbital foreign body.

Penetrating orbitocranial injuries caused by intraorbital foreign body are a rare cause of morbidity being most common among young people. The term intraorbital foreign body refers to a foreign body that occurs within the orbit but outside the ocular globe. We report the case of a 12-year-old male child who sustained a right cranial facial trauma due to accidental fall on a piece of wood, which penetrated intraorbitally. Native cranial magnetic resonance imaging (MRI -1.5 T) revealed the presence of an intraorbital foreign body, 6 cm long and 1.5 cm wide, near the orbital apex. In our patient, early surgical extraction of the foreign body had a decisive role on his full recovery. In this case, although a large foreign body penetrated the entire length of the orbit, it did not cause damage to any intraorbital structure. Vision and right ocular globe function had an excellent prognosis.

[Neurosurgeon-neuropathologist collaboration in cerebral tumors diagnosis]. / Colaborarea neurochirurg--neuropatolog în diagnosticarea tumorilor cerebrale.

The aim of the neurosurgical treatment in neuro-oncology is multiple: diagnostic (obtaining of a precise histopathological diagnosis to improve the treatment and the further prognosis), symptomatic (the improvement of the neurological clinical features by decreasing intracranial pressure) and therapeutic (to obtain a cytoreductive treatment, by complete or partial exeresis of the tumoural mass). To establish a precise histopathological diagnosis, during the intervention and latter, on the paraffin sections, the neuropathologist must examine the neurosurgical drawings knowing the history of the illness, the clinical and radiological aspects of the case in study, which complains a good cooperation between neurosurgeon and neuropathologist. To initiate the procedures of histopathological processing of various neurosurgical drawings, the neuropathologist must understand very well the surgical procedure. This is the reason of this study: to present different neurosurgical technics; the choose of one of these essentially depends on the location and size of the cerebral tumour, on neuroradiological characteristics and presumptive histopathological diagnosis and on the neurological status, the age and the general condition of the patient.