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2.
BMC Neurol ; 21(1): 18, 2021 Jan 12.
Artigo em Inglês | MEDLINE | ID: mdl-33435910

RESUMO

BACKGROUND: Dorsolateral medullary infarction is a typical cerebral infarction which is characterized by Wallenberg's syndrome. Neurotrophic keratopathy is an uncommon consequence of dorsolateral medullary infarction. At present, the protocol is aimed to study the dynamic changes in corneal innervation and the ocular surface environment after dorsolateral medullary infarction. METHODS: This study will involve consecutive data from all medical records of patients within 7 days of acute dorsolateral medullary infarction onset at the Departments of Neurology from 10 collaborating stroke centers. Eligible patients will mainly be characterized based on detailed physical examinations, multimodal imaging, and corneal related examinations and patients will be followed-up for 2 years. Neurotrophic keratopathy after dorsolateral medullary infarction is the primary endpoint. The dynamic histological corneal innervation and ocular surface environment after dorsolateral medullary infarction will be observed during the follow-up period. DISCUSSION: This multicentric, prospective registry is the first to identify and characterize the dynamic changes of corneal innervation and the ocular surface environment after acute dorsolateral medullary infarction. The significance of the study is to emphasize that the curative effect is based on the doctors' identification of the disease in the earliest stage before irreversible damage occurs to the cornea. TRIAL REGISTRATION: The registry was registered ( ChiCTR-OPC-17,011,625 ) on June 11, 2017.


Assuntos
Infarto Cerebral/complicações , Infarto Cerebral/patologia , Doenças da Córnea/etiologia , Sistema de Registros , Adulto , Feminino , Humanos , Masculino , Bulbo/patologia , Pessoa de Meia-Idade
3.
PLoS One ; 15(10): e0237643, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33064729

RESUMO

We previously reported that maternal cigarette smoke (CS) exposure resulted in impairment of central chemoreception and induced mitochondrial dysfunction in offspring parafacial respiratory group (pFRG), the kernel for mammalian central chemoreception. We also found that hydrogen sulfide (H2S) could attenuate maternal CS exposure-induced impairment of central chemoreception in the rat offspring in vivo. Mitochondrial ATP sensitive potassium (mitoKATP) channel has been reported to play a significant role in mitochondrial functions and protect against apoptosis in neurons. Thus, we hypothesize here that mitoKATP channel plays a role in the protective effects of H2S on neonatal central chemoreception in maternal CS-exposed rats. Our findings revealed that pretreatment with NaHS (donor of H2S, 22.4mM) reversed the central chemosensitivity decreased by maternal CS exposure, and also inhibited cell apoptosis in offspring pFRG, however, 5-HD (blocker of mitoKATP channels, 19mM) attenuated the protective effects of NaHS. In addition, NaHS declined pro-apoptotic proteins related to mitochondrial pathway apoptosis in CS rat offspring pFRG, such as Bax, Cytochrome C, caspase9 and caspase3. NaHS or 5-HD alone had no significant effect on above indexes. These results suggest that mitoKATP channels play an important role in the protective effect of H2S against impairment of central chemoreception via anti-apoptosis in pFRG of rat offspring exposed to maternal CS.


Assuntos
Células Quimiorreceptoras/efeitos dos fármacos , Fumar Cigarros/efeitos adversos , Sulfeto de Hidrogênio/metabolismo , Exposição Materna/efeitos adversos , Canais de Potássio/metabolismo , Animais , Animais Recém-Nascidos , Apoptose/efeitos dos fármacos , Células Quimiorreceptoras/patologia , Células Quimiorreceptoras/fisiologia , Feminino , Bulbo/efeitos dos fármacos , Bulbo/patologia , Bulbo/fisiopatologia , Gravidez , Efeitos Tardios da Exposição Pré-Natal/metabolismo , Substâncias Protetoras/metabolismo , Substâncias Protetoras/farmacologia , Ratos , Ratos Sprague-Dawley , Mecânica Respiratória/efeitos dos fármacos , Mecânica Respiratória/fisiologia , Sulfetos/metabolismo , Sulfetos/farmacologia
4.
Acta Neuropathol Commun ; 8(1): 147, 2020 08 26.
Artigo em Inglês | MEDLINE | ID: mdl-32847628

RESUMO

We document the neuropathologic findings of a 73-year old man who died from acute cerebellar hemorrhage in the context of relatively mild SARS-CoV2 infection. The patient developed sudden onset of headache, nausea, and vomiting, immediately followed by loss of consciousness on the day of admission. Emergency medical services found him severely hypoxemic at home, and the patient suffered a cardiac arrest during transport to the emergency department. The emergency team achieved return of spontaneous circulation after over 17 min of resuscitation. A chest radiograph revealed hazy bilateral opacities; and real-time-PCR for SARS-CoV-2 on the nasopharyngeal swab was positive. Computed tomography of the head showed a large right cerebellar hemorrhage, with tonsillar herniation and intraventricular hemorrhage. One day after presentation, he was transitioned to comfort care and died shortly after palliative extubation. Autopsy performed 3 h after death showed cerebellar hemorrhage and acute infarcts in the dorsal pons and medulla. Remarkably, there were microglial nodules and neuronophagia bilaterally in the inferior olives and multifocally in the cerebellar dentate nuclei. This constellation of findings has not been reported thus far in the context of SARS-CoV-2 infection.


Assuntos
Infartos do Tronco Encefálico/patologia , Doenças Cerebelares/patologia , Infecções por Coronavirus/patologia , Hemorragias Intracranianas/patologia , Microglia/patologia , Neurônios/patologia , Fagocitose , Pneumonia Viral/patologia , Idoso , Betacoronavirus , Infartos do Tronco Encefálico/complicações , Infartos do Tronco Encefálico/diagnóstico por imagem , Doenças Cerebelares/complicações , Doenças Cerebelares/diagnóstico por imagem , Núcleos Cerebelares/patologia , Infecções por Coronavirus/complicações , Infecções por Coronavirus/diagnóstico , Cefaleia/etiologia , Parada Cardíaca/etiologia , Humanos , Hipóxia/etiologia , Hemorragias Intracranianas/complicações , Hemorragias Intracranianas/diagnóstico por imagem , Masculino , Bulbo/diagnóstico por imagem , Bulbo/patologia , Núcleo Olivar/patologia , Pandemias , Pneumonia Viral/complicações , Pneumonia Viral/diagnóstico , Tegmento Pontino/diagnóstico por imagem , Tegmento Pontino/patologia , Tomografia Computadorizada por Raios X
5.
BMC Neurol ; 20(1): 201, 2020 May 21.
Artigo em Inglês | MEDLINE | ID: mdl-32438902

RESUMO

BACKGROUND: Stress cardiomyopathy (Takotsubo cardiomyopathy) is very rare in the central nervous system (CNS) demyelinating disorders. Although this dysfunction of the heart-brain axis has been reported in several case series related to multiple sclerosis (MS), stress cardiomyopathy by neuromyelitis optica (NMO), which is rarer CNS demyelinating disorder than MS, is extremely rare. Herein, we report a case of stress cardiomyopathy associated with a medullary lesion as a presentation of NMO. CASE PRESENTATION: A 30-year-old woman was treated by veno-arterial extracorporeal membrane oxygenation due to catastrophic cardiopulmonary dysfunction after prolonged and unexplained nausea, vomiting, and cough. Myoclonus on the limbs developed afterward. Taken with suspicion of area postrema syndrome (APS), the brain MRI showed a demyelinating lesion in the medulla oblongata. APS and severe heart failure by stress cardiomyopathy were completely resolved by ECMO and hydrocortisone therapy. However, the CNS demyelinating lesion recurred after 1 month. The patient was diagnosed with NMO evident by the presence of aquaporin-4 antibody; Steroid therapy improved her symptoms. CONCLUSION: NMO should be considered as one of the differential diagnoses in patients with APS preceding severe cardiopulmonary distress.


Assuntos
Área Postrema , Neuromielite Óptica/diagnóstico , Cardiomiopatia de Takotsubo/diagnóstico , Adulto , Aquaporina 4/imunologia , Autoanticorpos/sangue , Diagnóstico Diferencial , Feminino , Humanos , Imageamento por Ressonância Magnética , Bulbo/patologia , Recidiva , Síndrome
6.
BMC Neurol ; 20(1): 180, 2020 May 12.
Artigo em Inglês | MEDLINE | ID: mdl-32397962

RESUMO

BACKGROUND: The etiologic determinants of cryptogenic stroke remain a diagnostic challenge in clinical practice. Fabry disease (FD) is one of the monogenic causes of stroke that may remain unrecognized as a potential contributing causative factor, because of its rarity and difficulty in diagnosis. We report a case with rare bilateral medial medullary infarction manifesting as "heart appearance" who was diagnosed with FD. CASE PRESENTATION: A 51-year-old Chinese man presented with acute dysarthria and mild tetraparesis. In the 24 h following admission, the patient rapidly developed progressive flaccid quadriplegia and tongue weakness, necessitating ventilator support. Immediate magnetic resonance imaging of the brain showed heart-shaped appearance of bilateral medial medullary infarction. The patient suffered two new subcortical infarcts 40 days after the first. Detailed Family history and physical examination indicated symptoms consistent with FD, which was confirmed by very low alpha galactosidase A levels and a missense mutation of the alpha-galactosidase A gene. CONCLUSIONS: We report what appears to be the first case of FD manifesting as bilateral medial medullary infarction. Our case suggests that clinicians should consider the possibility of FD in patients with cryptogenic stroke, especially when combined with infarction in the vertebrobasilar artery system, renal insufficiency, or cardiomyopathy. A detailed analysis of subtle historical clues and performing a complete physical examination on stroke patients would help promote earlier diagnosis of FD.


Assuntos
Doença de Fabry/complicações , Acidente Vascular Cerebral/etiologia , Doença de Fabry/diagnóstico , Humanos , Imageamento por Ressonância Magnética/métodos , Masculino , Bulbo/diagnóstico por imagem , Bulbo/patologia , Pessoa de Meia-Idade , Acidente Vascular Cerebral/diagnóstico por imagem
7.
BMC Neurol ; 20(1): 107, 2020 Mar 23.
Artigo em Inglês | MEDLINE | ID: mdl-32293317

RESUMO

BACKGROUND: Bilateral medial medullary infarction (MMI) is uncommon and bilateral medial pons infarction (MPI) is even rarer. "Heart appearance" on magnetic resonance imaging (MRI) is a characteristic presentation of bilateral medial medullary infarction (MMI). CASE PRESENTATION: We present 67-year-old Chinese diabetic and hypertensive female patient affected with "heart appearance-like" infarction in bilateral ponto-medullary junction on MRI. Abnormal signal was observed in the bilateral ponto-medullary junction on T1, T2, fluid-attenuated inversion recovery and apparent diffusion coefficient (ADC). The whole brain digital subtraction angiography (DSA) showed the basilar artery and vertebral artery remained intact. Therefore, we speculated that the bilateral ponto-medullary junction infarction might be caused by the deep perforating branch of the basilar artery. CONCLUSIONS: As far as we know, the "heart appearance-like" infraction in bilateral ponto-medullary junction was not reported. Our case also suggests that bilateral ischemic infraction involvement of the medulla and pon is possible even in the context of an intact basilar artery.


Assuntos
Infartos do Tronco Encefálico/patologia , Imageamento por Ressonância Magnética , Bulbo/patologia , Idoso , Angiografia Digital , Artéria Basilar/patologia , Encéfalo/patologia , Humanos , Masculino , Ponte/patologia , Artéria Vertebral/patologia
8.
World Neurosurg ; 136: 444-453, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32204296

RESUMO

BACKGROUND: Cervicomedullary compression in young children has been described in the context of Chiari type 1 malformation, with symptoms associated with the extent of tonsillar herniation below McRae line. Historically, Chiari type 1 malformation has been defined by tonsillar herniation of at least 5 mm. However, in certain populations, including very young children, Chiari symptoms may be present without this finding. A new Chiari classification is thus necessary. METHODS: Cases involving patients up to 5 years of age evaluated for possible posterior fossa decompression were retrospectively reviewed. Preoperative symptoms, magnetic resonance imaging findings, surgical management, and short- and long-term outcome and follow-up were recorded. Tonsillar descent and presence of ventral herniation (VH) were recorded. We define VH as the tonsils crossing a line that bisects the caudal medulla at the level of the foramen magnum, thus creating a novel entity, Chiari type 0.5 malformation. Patients with ventrally herniated tonsils were compared with patients exhibiting more typical Chiari morphology. RESULTS: Of 41 cases retrospectively reviewed, 20 met criteria for VH. These differed from cases without VH because of the predominance of medullary symptoms. In the VH cohort, 11 patients underwent surgical decompression with symptom resolution; 9 were initially managed conservatively, but 3 subsequently required surgery. CONCLUSIONS: We define a novel Chiari entity, Chiari type 0.5 malformation, characterized by ventral tonsillar wrapping around the medulla in young children in the absence of classic Chiari type 1 malformation imaging findings. These patients are more likely to present with medullary symptoms than patients without VH. They are also more likely to require surgical decompression and respond favorably to intervention.


Assuntos
Malformação de Arnold-Chiari/diagnóstico , Malformação de Arnold-Chiari/patologia , Tonsila Palatina/patologia , Malformação de Arnold-Chiari/cirurgia , Pré-Escolar , Tratamento Conservador , Fossa Craniana Posterior/cirurgia , Descompressão Cirúrgica/métodos , Encefalocele/diagnóstico por imagem , Encefalocele/cirurgia , Feminino , Seguimentos , Humanos , Lactente , Imageamento por Ressonância Magnética , Masculino , Bulbo/patologia , Bulbo/cirurgia , Tonsila Palatina/cirurgia , Estudos Retrospectivos , Resultado do Tratamento
9.
BMJ Case Rep ; 13(3)2020 Mar 10.
Artigo em Inglês | MEDLINE | ID: mdl-32161079

RESUMO

Brain abscesses represent areas of localised infection of the brain parenchyma. Those confined to the brainstem are rare and usually fatal if untreated. Streptococcus intermedius is a common causative organism of brain abscesses and is associated with significant morbidity. We describe a case report of medullary abscess secondary to dental infection in a 68-year-old patient. The patient presented with headaches and flu-like symptoms progressing to left hemiparesis and reduced consciousness/bulbar function. The patient underwent emergency posterior fossa craniectomy and drainage with subsequent medical management with antibiotics. Prompt diagnosis, early surgical intervention and maximal therapy with antibiotics alongside extensive rehabilitation are all vital to ensure good neurological outcome. It is imperative for medical practitioners to consider the diagnosis of brain abscess in patients presenting with rapid onset neurological deterioration. Such cases require early neurological imaging with involvement of tertiary neurosurgery services.


Assuntos
Abscesso Encefálico/diagnóstico , Infecções Estreptocócicas/complicações , Idoso , Antibacterianos/uso terapêutico , Abscesso Encefálico/etiologia , Abscesso Encefálico/patologia , Abscesso Encefálico/terapia , Craniotomia/métodos , Drenagem , Humanos , Imageamento por Ressonância Magnética , Masculino , Bulbo/patologia , Streptococcus intermedius/isolamento & purificação , Tomografia Computadorizada por Raios X
10.
J Neuroinflammation ; 17(1): 15, 2020 Jan 10.
Artigo em Inglês | MEDLINE | ID: mdl-31924219

RESUMO

BACKGROUND: Microglial mediated neuroinflammation in the rostral ventrolateral medulla (RVLM) plays roles in the etiology of stress-induced hypertension (SIH). It was reported that autophagy influenced inflammation via immunophenotypic switching of microglia. High-mobility group box 1 (HMGB1) acts as a regulator of autophagy and initiates the production of proinflammatory cytokines (PICs), but the underlying mechanisms remain unclear. METHODS: The stressed mice were subjected to intermittent electric foot shocks plus noises administered for 2 h twice daily for 15 consecutive days. In mice, blood pressure (BP) and renal sympathetic nerve activity (RSNA) were monitored by noninvasive tail-cuff method and platinum-iridium electrodes placed respectively. Microinjection of siRNA-HMGB1 (siHMGB1) into the RVLM of mice to study the effect of HMGB1 on microglia M1 activation was done. mRFP-GFP-tandem fluorescent LC3 (tf-LC3) vectors were transfected into the RVLM to evaluate the process of autolysosome formation/autophagy flux. The expression of RAB7, lysosomal-associated membrane protein 1 (LAMP1), and lysosomal pH change were used to evaluate lysosomal function in microglia. Mitophagy was identified by transmission electron microscopic observation or by checking LC3 and MitoTracker colocalization under a confocal microscope. RESULTS: We showed chronic stress increased cytoplasmic translocations of HMGB1 and upregulation of its receptor RAGE expression in microglia. The mitochondria injury, oxidative stress, and M1 polarization were attenuated in the RVLM of stressed Cre-CX3CR1/RAGEfl/fl mice. The HMGB1/RAGE axis increased at the early stage of stress-induced mitophagy flux while impairing the late stages of mitophagy flux in microglia, as revealed by decreased GFP fluorescence quenching of GFP-RFP-LC3-II puncta and decreased colocalization of lysosomes with mitochondria. The expressions of RAB7 and LAMP1 were decreased in the stressed microglia, while knockout of RAGE reversed these effects and caused an increase in acidity of lysosomes. siHMGB1 in the RVLM resulted in BP lowering and RSNA decreasing in SIH mice. When the autophagy inducer, rapamycin, is used to facilitate the mitophagy flux, this treatment results in attenuated NF-κB activation and reduced PIC release in exogenous disulfide HMGB1 (ds-HMGB1)-stimulated microglia. CONCLUSIONS: Collectively, we demonstrated that inhibition of the HMGB1/RAGE axis activation led to increased stress-induced mitophagy flux, hence reducing the activity of microglia-mediated neuroinflammation and consequently reduced the sympathetic vasoconstriction drive in the RVLM.


Assuntos
Proteína HMGB1/metabolismo , Bulbo/patologia , Microglia/patologia , Receptor para Produtos Finais de Glicação Avançada/metabolismo , Estresse Psicológico/metabolismo , Animais , Hipertensão/metabolismo , Inflamação/metabolismo , Bulbo/metabolismo , Camundongos , Camundongos Endogâmicos C57BL , Microglia/metabolismo , Mitofagia , Angústia Psicológica , Transdução de Sinais/fisiologia , Estresse Psicológico/patologia
11.
Regul Toxicol Pharmacol ; 111: 104547, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31816339

RESUMO

BIA 10-2474 (3-(1-(cyclohexyl(methyl)carbamoyl)-1H-imidazol-4-yl)pyridine 1-oxide) is a novel fatty acid amide hydrolase (FAAH) inhibitor developed by BIAL for the treatment of medical conditions which would benefit from enhanced levels of endogenous anandamide (AEA) such as pain disorders. During a Phase I clinical trial one subject died after receiving BIA 10-2474 and others displayed neurological signs. As part of series of papers presenting all the toxicology data available prior to the clinical trial we report here the nonclinical toxicology studies performed in cynomolgus monkeys. Maximum Tolerated Dose (MTD) studies and a preliminary 14-day study by oral (capsule) administration of BIA 10-2474 established a dose between 90 and 120 mg/kg/day as a suitable high dose for a subsequent regulatory toxicity studies. An up-titration scheme was used to achieve these doses. The dose-limiting effect was the early sacrifice for ethical reasons of monkeys at doses from 125 mg/kg/day upwards. Thereafter, regulatory 4- and 13-week oral gavage toxicity studies followed by a 2- or a 4-week recovery period, respectively, were performed. In both cases a 3-4-week up-titration period was used prior to repeat dosing with the target doses. One female was euthanized during the up-titration period after receiving 9 administrations of 75 mg/kg as a result of bleeding erosion on the feet and hands and ulceration on the tongue. These signs were not seen in any other monkeys during these studies. Doses of 10, 50 or 100 mg/kg/day were administered during the 4-week study and clinical signs related to the pharmacological action of BIA 10-2474 (e.g., tremors and weakness, incoordination and loss of balance, reduction in food intake and reduced body weight) were observed in several monkeys from the intermediate and high dose. Histological alterations consisted of axonal dystrophy in the fasciculus cuneatus (dorsal medulla oblongata) characterized by swollen axons and myelin sheath edema, edema in the pars nervosa of the pituitary gland and vacuolation of Meissner's plexus ganglia in all gastrointestinal segments. All lesions recovered and a dose of 100 mg/kg/day was considered to be the NOAEL. In the 13-week oral study the monkeys received BIA 10-2474 daily by gavage at a dose of 6.25, 37.5 or 75 mg/kg/day. Similar clinical signs and histological alterations as noted in monkeys of the 28-day study were observed in monkeys at 37.5 or 75 mg/kg/day. All findings recovered, and the dose of 75 mg/kg/day was considered the NOAEL.


Assuntos
Comportamento Animal/efeitos dos fármacos , Óxidos N-Cíclicos/administração & dosagem , Óxidos N-Cíclicos/toxicidade , Bulbo/efeitos dos fármacos , Piridinas/administração & dosagem , Piridinas/toxicidade , Administração Oral , Animais , Relação Dose-Resposta a Droga , Eutanásia , Feminino , Macaca fascicularis , Masculino , Dose Máxima Tolerável , Bulbo/patologia
12.
Regul Toxicol Pharmacol ; 111: 104540, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31759138

RESUMO

BIA 10-2474 is a novel fatty acid amide hydrolase (FAAH) inhibitor developed for the treatment of medical conditions which would benefit from enhanced levels of endogenous anandamide (AEA) such as pain disorders. During a Phase I clinical trial one subject died after receiving BIA 10-2474 and four other subjects displayed neurological signs. As part of series of papers presenting all the toxicology data available prior to the clinical trial, we report here the preclinical toxicology studies examining once-a-day oral administration of BIA 10-2474 to male and female Wistar rats. These included a 14-day dose range finding (150, 200 and 250 mg/kg/day), a 4-week study (30, 90 and 150 mg/kg/day) and 13- and 26-week studies (both at 10, 30 and 90 mg/kg/day). The 13- and 26-week studies also included a 4-week recovery arm and a toxicokinetic arm for the parent compound, BIA 10-2474, and the two major metabolites (BIA 10-2445 and BIA 10-2583) were also measured in the 26-week study. At 150 mg/kg and below, all animals survived the scheduled treatment periods although neurological side-effects (abnormal or stiff gait, dragging of fore- or hind-limbs) were seen at 150 mg/kg in both the dose-range finding and 4-week studies. At 90 mg/kg/day, even up to 26-weeks treatment, no clinical signs were seen apart from some decreases in body weight gain. A number of consistent hematological and biochemical changes were noted which were considered related to treatment with BIA 10-2474. Morphologically, in the 4-week study, except for a slight gliosis in the hippocampus of one female at 150 mg/kg, no CNS histopathology was observed; hippocampus gliosis was not observed in subsequent studies. In the 13-week study axonal swelling was present in the medulla oblongata in about half the animals at 90 mg/kg/day and this increased to nearly all the rats at 90 mg/kg/day in the 26-week study. Additional signs seen only in the 26-week study at 90 mg/kg/day included axonal swelling of the fasiculus gracilis and vacuolar changes in the medulla oblongata and ventral commissure of the 3rd ventricle. Other findings included vacuolar degeneration in the ganglia of the GI tract, salivary glands, prostate gland, uterus, and parathyroid glands. The pituitary gland showed edema and mitotic figures in the pars nervosa. These observations outside the CNS were seen in most rats at 90 and 150 mg/kg/day independent of study duration. At 30 mg/kg/day, most of these observations were only seen in isolated cases except for the vacuolar degeneration in GI tract ganglia, which was absent at this dose after 4 weeks treatment but was present in almost all rats at 13 and 26 weeks. Hepatocellular hypertrophy and nephropathy were seen across all studies and the extent of these changes was similar in the 13- and 26-week studies. Most findings resolved after the 4-week recovery periods except for the axonal swelling seen in the medulla oblongata and spinal cord. BIA 10-2474 exposure was markedly higher than the exposure to either metabolite, BIA 10-2445 (19- to 192-fold) and BIA 10-2583 (63- to 526-fold). Exposure to metabolites differed between sexes with higher concentrations of BIA 10-2445 in females compared to males, but the inverse for BIA 10-2583. Although a No Observed Adverse Effect Level (NOAEL) of 30 mg/kg/day was concluded following the 4-week study, the histopathological findings at that dose in the 13- and 26-week studies resulted in the NOAEL being determined to be 10 mg/kg/day.


Assuntos
Óxidos N-Cíclicos/administração & dosagem , Óxidos N-Cíclicos/toxicidade , Bulbo/efeitos dos fármacos , Piridinas/administração & dosagem , Piridinas/toxicidade , Medula Espinal/efeitos dos fármacos , Testes de Toxicidade , Administração Oral , Animais , Óxidos N-Cíclicos/metabolismo , Feminino , Masculino , Bulbo/patologia , Nível de Efeito Adverso não Observado , Piridinas/metabolismo , Ratos , Ratos Wistar , Medula Espinal/patologia
13.
BMC Neurol ; 19(1): 341, 2019 Dec 27.
Artigo em Inglês | MEDLINE | ID: mdl-31881866

RESUMO

BACKGROUND: To evaluate the efficacy of microvascular decompression (MVD) in reducing hypertension (HTN) in hypertensive patients with trigeminal neuralgia (TN). METHODS: The clinical data of 58 cases of neurogenic HTN with TN treated in our hospital were retrospectively reviewed. Preoperative MR revealed abnormal blood pressure in the left rostral ventrolateral medulla (RVLM) and the posterior cranial nerve root entry zone (REZ). The patients were divided into control group: only trigeminal nerve was treated with MVD; experimental group: trigeminal nerve, RVLM and REZ were treated with MVD at the same time. The patients were followed up for 6 months to 1 year to observe the changes of blood pressure. RESULTS: There was no significant difference in gender, age, course of TN, course of HTN, grade of HTN and preoperative blood pressure between the two groups. After operation, the effective rate of HTN improvement with MVD was 32.1% in the control group. There was no significant difference in the preoperative and post operative blood pressure. (P△SBP = 0.131; P△BDP = 0.078). In the experimental group, the effective rate was 83.3%. The postoperative blood pressure was significantly lower than preoperative values. (P△SBP < 0.001; P△DBP < 0.001). CONCLUSIONS: MVD is an effective treatment for neurogenic HTN. However, the criteria for selecting hypertensive patients who need MVD to control their HTN still needs to be further determined. Possible indications may include: left trigeminal neuralgia, neurogenic HTN; abnormal blood pressure compression in the left RVLM and REZ areas on MR; and blood pressure in these patients can not be effectively controlled by drugs.


Assuntos
Hipertensão/etiologia , Hipertensão/cirurgia , Bulbo/cirurgia , Cirurgia de Descompressão Microvascular/métodos , Doenças Vasculares/cirurgia , Adulto , Idoso , Feminino , Humanos , Masculino , Bulbo/patologia , Pessoa de Meia-Idade , Estudos Retrospectivos , Resultado do Tratamento , Neuralgia do Trigêmeo/etiologia , Neuralgia do Trigêmeo/cirurgia , Doenças Vasculares/complicações
14.
Muscle Nerve ; 60(6): 762-768, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31498901

RESUMO

INTRODUCTION: Equine recurrent laryngeal neuropathy (RLN) is a naturally occurring model of length-dependent axonopathy characterized by asymmetrical degeneration of recurrent laryngeal nerve axons (RLn). Distal RLn degeneration is marked, but it is unclear whether degeneration extends to include cell bodies (consistent with a neuronopathy). METHODS: With examiners blinded to RLN severity, brainstem location, and side, we examined correlations between RLN severity (assessed using left distal RLn myelinated axon count) and histopathological features (including chromatolysis and glial responses) in the nucleus ambiguus cell bodies, and myelinated axon count of the right distal RLn of 16 horses. RESULTS: RLN severity was not associated with RLn cell body number (P > .05), or degeneration. A positive correlation between the left and right distal RLn myelinated axon counts was identified (R2 = 0.57, P < .05). DISCUSSION: We confirm that RLN, a length-dependent distal axonopathy, occurs in the absence of detectable neuronopathy.


Assuntos
Corpo Celular/patologia , Bulbo/patologia , Fibras Nervosas Mielinizadas/patologia , Neurônios/patologia , Nervo Laríngeo Recorrente/patologia , Paralisia das Pregas Vocais/patologia , Animais , Atrofia , Contagem de Células , Cavalos , Nervo Laríngeo Recorrente/fisiopatologia , Paralisia das Pregas Vocais/fisiopatologia
16.
World Neurosurg ; 132: 69-74, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31470167

RESUMO

BACKGROUND: Immunoglobulin (Ig)G4-related disease (IgG4-RD) was defined only recently and can be found in many organs. As intracranial lesions, hypophysitis and pachymeningitis are well known, whereas intracranial pseudotumor is unusual. This case involved multiple intracranial pseudotumors without extracranial lesions, mimicking multiple meningioma. CASE DESCRIPTION: A 72-year-old woman was referred to our hospital with an incidental mass lesion at the craniocervical junction on magnetic resonance imaging (MRI). MRI showed diffuse enhanced extra-axial nodules around the medulla and middle cranial fossa. Surgery was performed for the gradually enlarging tumor. Intraoperative findings showed hard nodules around the vertebral artery. We performed subtotal resection. Neuropathological findings showed diffuse lymphoplasmacytic infiltration with lymphoid follicles. Immunohistochemical studies for IgG4 and IgG showed the histological criteria for IgG4-RD were met. Given the high IgG4 serum level, we diagnosed IgG4-RD. Steroid was administered initially but was then tapered, and nodules have since remained small. CONCLUSIONS: This case demonstrates IgG4-RD mimicking meningioma with multiple masses but without extracranial lesions. This case and previous descriptions suggest the possibility of pseudotumor due to IgG4-RD in the presence of multiple extra-axial lesions at the dura and supplying artery, hard nodules with thickening of the artery, and frozen section findings of lymphoplasmacytes surrounded by rich collagen fibers. In such cases, the pseudotumor due to IgG4-RD should be resected, and total resection might not be warranted.


Assuntos
Doença Relacionada a Imunoglobulina G4/patologia , Bulbo/patologia , Idoso , Fossa Craniana Média/diagnóstico por imagem , Fossa Craniana Média/patologia , Diagnóstico Diferencial , Feminino , Humanos , Doença Relacionada a Imunoglobulina G4/diagnóstico por imagem , Doença Relacionada a Imunoglobulina G4/cirurgia , Bulbo/diagnóstico por imagem , Bulbo/cirurgia , Neoplasias Meníngeas/diagnóstico , Meningioma/diagnóstico , Neoplasias Primárias Múltiplas/diagnóstico
17.
Artigo em Alemão | MEDLINE | ID: mdl-31434127

RESUMO

We describe the magnetic resonance imaging (MRI) examination in a dog with confirmed suid herpesvirus 1 (SHV-1) infection and compare the findings to the results of the histopathologic examination. A 5-year-old female German Hunting Terrier used for hunting displayed severe pruritus and fever 7 days after contact with a wild boar. Two days after the onset of the first disease symptoms, the dog was presented with seizures and hyperthermia. MRI examination revealed hyperintense alterations in the occipital, temporal and parietal lobe areas. In the contrast sequences, contrast enhancement of the medulla oblongata as well as of the pachy- and leptomeninges within the occipital lobe and the cerebellum could be detected. The bitch was euthanized because of the acute deterioration of its condition. Histopathologically, multifocal mild to moderate mixed cellular vasculitis and satellitosis were found in the brain stem and pons, where SHV-1 antigen was detectable immunohistochemically in neurons and glial cells. In molecular-biological studies of the trigeminal ganglion and the medulla oblongata, SHV-1-specific DNA was detected. The MRI lesions of our patient displayed marked differences to the changes described in the literature for central European tick-borne meningoencephalomyelitis or the paralytic course of rabies. By contrast, it appears that similarities to the lesions described in canine distemper and the encephalitic form of rabies did exist.


Assuntos
Encéfalo/diagnóstico por imagem , Encéfalo/patologia , Doenças do Cão/diagnóstico por imagem , Pseudorraiva/diagnóstico por imagem , Animais , Antígenos Virais/isolamento & purificação , Tronco Encefálico/diagnóstico por imagem , Tronco Encefálico/patologia , Cerebelo/diagnóstico por imagem , Cerebelo/patologia , Cérebro/diagnóstico por imagem , Cérebro/patologia , Doenças do Cão/patologia , Doenças do Cão/virologia , Cães , Evolução Fatal , Feminino , Febre/veterinária , Herpesvirus Suídeo 1/imunologia , Herpesvirus Suídeo 1/isolamento & purificação , Imuno-Histoquímica/veterinária , Imageamento por Ressonância Magnética/veterinária , Bulbo/diagnóstico por imagem , Bulbo/patologia , Meninges/diagnóstico por imagem , Meninges/patologia , Pseudorraiva/patologia , Pseudorraiva/virologia , Convulsões/veterinária , Sus scrofa
18.
World Neurosurg ; 129: 200-201, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31426252

RESUMO

Only few case reports of intradural extramedullary-located cavernous angiomas are available. This report describes an extra-axial hemorrhagic lesion located on the lateral surface of the medulla oblongata at the foramen magnum. Follow-up magnetic resonance imaing clearly demonstrated growth of the lesion, probably due to repetitive intralesional hemorrhaging. Initially, a right vertebral artery aneurysm or an arteriovenous malformation was suspected. Digital subtraction angiography excluded these differential diagnoses, although doubt remained concerning the possibility of a thrombosed aneurysm. Preoperatively, the lesion did not had the typical macroscopical aspect of a cavernoma and appeared rather as an expansive encapsulated multicystic vascular lesion. Nevertheless, pathologic analysis confirmed the diagnosis of a cavernous hemangioma. Complete microsurgical resection was obtained without neurologic impairment.


Assuntos
Neoplasias do Tronco Encefálico/cirurgia , Hemangioma Cavernoso do Sistema Nervoso Central/cirurgia , Bulbo/cirurgia , Neoplasias do Tronco Encefálico/patologia , Feminino , Forame Magno/patologia , Forame Magno/cirurgia , Hemangioma Cavernoso do Sistema Nervoso Central/patologia , Humanos , Bulbo/patologia , Pessoa de Meia-Idade
19.
Radiographics ; 39(4): 1110-1125, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31283463

RESUMO

The anatomy of the brainstem is complex. It contains numerous cranial nerve nuclei and is traversed by multiple tracts between the brain and spinal cord. Improved MRI resolution now allows the radiologist to identify a higher level of anatomic detail, but an understanding of functional anatomy is crucial for correct interpretation of disease. Brainstem syndromes are most commonly due to occlusion of the posterior circulation or mass effect from intrinsic space-occupying lesions. These syndromes can have subtle imaging findings that may be missed by a radiologist unfamiliar with the anatomy or typical manifesting features. This article presents the developmental anatomy of the brainstem and discusses associated pathologic syndromes. Congenital and acquired syndromes are described and correlated with anatomic locations at imaging, with diagrams to provide a reference to aid in radiologic interpretation. ©RSNA, 2019.


Assuntos
Imageamento por Ressonância Magnética/métodos , Bulbo/diagnóstico por imagem , Mesencéfalo/diagnóstico por imagem , Neuroimagem/métodos , Ponte/diagnóstico por imagem , Encefalopatias/diagnóstico por imagem , Infarto Encefálico/diagnóstico por imagem , Anormalidades Craniofaciais/diagnóstico por imagem , Humanos , Bulbo/anatomia & histologia , Bulbo/patologia , Mesencéfalo/anatomia & histologia , Mesencéfalo/patologia , Ponte/anatomia & histologia , Ponte/patologia , Síndrome
20.
World Neurosurg ; 130: 400-404, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31326640

RESUMO

BACKGROUND: Intracranial solitary fibrous tumor (SFT) is a rare occurrence and involvement of the fourth ventricle rarely reported. Because of its rarity, some characteristics of intracranial SFT seem to still remain uncertain. CASE DESCRIPTION: This study describes a very rare case of intracranial SFT in a 55-year-old woman who presented with gait disturbance and numbness in bilateral upper limbs from 3 months before visiting the hospital. Head magnetic resonance imaging scan revealed a homogeneously enhancing mass lesion located primarily in the fourth ventricle extending into the spinal canal and left foramen of Luschka, with a maximum diameter of 60 mm. Notably, this tumor presented spontaneous partial regression during waiting planned surgery without therapy, including chemotherapy and radiotherapy. This patient underwent a midline suboccipital craniotomy and resection of the tumor. Interestingly, there was no attachment to the dura mater of the posterior cranial fossa and the lesion was only attached to the dorsal part of the medulla oblongata. CONCLUSIONS: Although the location of the SFT in the fourth ventricle is rare, SFT should be considered as 1 of the differential diagnosis of fourth ventricle tumors. In addition, this case indicates that SFT in the fourth ventricle may regress on occasion spontaneously without a precisely known cause for this spontaneous partial regression.


Assuntos
Neoplasias do Tronco Encefálico/patologia , Bulbo/patologia , Tumores Fibrosos Solitários/patologia , Neoplasias do Tronco Encefálico/cirurgia , Craniotomia/métodos , Feminino , Humanos , Imageamento por Ressonância Magnética , Bulbo/cirurgia , Pessoa de Meia-Idade , Neoplasia Residual/cirurgia , Doenças Raras , Remissão Espontânea , Tumores Fibrosos Solitários/cirurgia
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