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1.
Anticancer Res ; 40(10): 5787-5792, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32988906

RESUMO

BACKGROUND/AIM: Hypothalamic-pituitary (HT-P) dysfunction is one of the most common endocrine late effects following cranial radiotherapy. However, there are currently no specific data describing this complication in adult-onset cancer patients after whole brain radiotherapy (WBRT). The present cohort study aims to establish the prevalence of HT-P axis dysfunction in this group of patients. PATIENTS AND METHODS: Twenty-six cancer patients previously treated with WBRT (median follow-up=20.5 months) received standardized endocrine check-up focusing on HT-P function. RESULTS: In 50% of the patients, impaired hypothalamic-pituitary function was detected during follow-up. While functional loss of a single hormonal axis was evident in 34.6% of patients, 7.7% showed an impairment of multiple endocrine axes, and one patient developed adrenocorticotropic hormone deficiency. Hypothalamic-pituitary dysfunction did not directly correlate with the applied WBRT total doses. CONCLUSION: In our cohort, hypothalamic-pituitary dysfunction appeared to be common after WBRT and was diagnosed as early as 6 months following radiation. This finding highlights the need for routine endocrine follow-up even in patients with limited life expectancy.


Assuntos
Neoplasias Encefálicas/radioterapia , Irradiação Craniana/efeitos adversos , Sistema Hipotálamo-Hipofisário/efeitos da radiação , Hipófise/efeitos da radiação , Adulto , Idoso , Idoso de 80 Anos ou mais , Neoplasias Encefálicas/complicações , Neoplasias Encefálicas/patologia , Feminino , Humanos , Sistema Hipotálamo-Hipofisário/fisiopatologia , Hipotálamo/fisiopatologia , Hipotálamo/efeitos da radiação , Masculino , Pessoa de Meia-Idade , Hipófise/fisiopatologia , Lesões por Radiação/fisiopatologia
2.
Pediatrics ; 146(2)2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32732262

RESUMO

OBJECTIVES: Acute nystagmus (AN) is an uncommon neurologic sign in children presenting to pediatric emergency departments. We described the epidemiology, clinical features, and underlying causes of AN in a large cohort of children, aiming at identifying features associated with higher risk of severe underlying urgent conditions (UCs). METHODS: Clinical records of all patients aged 0 to 18 years presenting for AN to the pediatric emergency departments of 9 Italian hospitals in an 8-year period were retrospectively reviewed. Clinical and demographic features and the underlying causes were analyzed. A logistic regression model was applied to detect predictive variables associated with a higher risk of UCs. RESULTS: A total of 206 patients with AN were included (male-to-female ratio: 1.01; mean age: 8 years 11 months). The most frequently associated symptoms were headache (43.2%) and vertigo (42.2%). Ataxia (17.5%) and strabismus (13.1%) were the most common neurologic signs. Migraine (25.7%) and vestibular disorders (14.1%) were the most common causes of AN. Idiopathic infantile nystagmus was the most common cause in infants <1 year of age. UCs accounted for 18.9% of all cases, mostly represented by brain tumors (8.3%). Accordant with the logistic model, cranial nerve deficits, ataxia, or strabismus were strongly associated with an underlying UC. Presence of vertigo or attribution of a nonurgent triage code was associated with a reduced risk of UCs. CONCLUSIONS: AN should be considered an alarming finding in children given the risk of severe UCs. Cranial nerve palsy, ataxia, and strabismus should be considered red flags during the assessment of a child with AN.


Assuntos
Nistagmo Patológico/etiologia , Ataxia/complicações , Ataxia/diagnóstico , Neoplasias Encefálicas/complicações , Neoplasias Encefálicas/diagnóstico , Infecções do Sistema Nervoso Central/complicações , Infecções do Sistema Nervoso Central/diagnóstico , Criança , Pré-Escolar , Estudos de Coortes , Doenças dos Nervos Cranianos/complicações , Doenças dos Nervos Cranianos/diagnóstico , Doenças Desmielinizantes/complicações , Doenças Desmielinizantes/diagnóstico , Tontura/etiologia , Serviço Hospitalar de Emergência , Feminino , Cefaleia/etiologia , Humanos , Hipertensão Intracraniana/complicações , Hipertensão Intracraniana/diagnóstico , Itália , Masculino , Transtornos de Enxaqueca/complicações , Transtornos de Enxaqueca/diagnóstico , Náusea/etiologia , Envenenamento/complicações , Envenenamento/diagnóstico , Estudos Retrospectivos , Estrabismo/etiologia , Vertigem/etiologia , Doenças Vestibulares/complicações , Doenças Vestibulares/diagnóstico , Vômito/etiologia
3.
Medicine (Baltimore) ; 99(28): e21002, 2020 Jul 10.
Artigo em Inglês | MEDLINE | ID: mdl-32664104

RESUMO

RATIONALE: The orexin projection system includes the lateral hypothalamus, reticular activating structure, and ventrolateral preoptic nucleus, and this system is related to the pathogenesis of narcolepsy. Here, we report a case of narcolepsy type 2 caused by hippocampal glioma of the right temporal lobe. PATIENT CONCERNS: A 44-year-old male farmer complained of excessive daytime sleepiness (EDS) over the past 3 months and more. INTERVENTIONS: The lesion of the right anteromedial temporal lobe was removed and its pathological examination was carried out. OUTCOMES: General examination showed no abnormalities of his heart, lungs, or abdomen. Neurological examination showed no positive sign. The blood routine and biochemical examination were normal. He scored 7 on the Pittsburg sleep quality index, 16 on the Epworth sleepiness scale, 52 on the self-rating anxiety scale, and 48 on the self-rating depression scale. The multiple sleep latency test data showed 2 periods of sleep-onset rapid eyes movement period across 4 successive tests; the average sleep latency was under 8 minutes, and the rapid eyes movement latency was under 7 minutes. Lesion of glioma in hippocampus area of the right anteromedial temporal lobe was confirmed through magnetic resonance imaging, magnetic resonance spectroscopy, and histological examination. After surgical removal of the glioma from the hippocampus area of the right anteromedial temporal lobe, the patient's EDS symptoms disappeared immediately. He scored 3 on the Epworth sleepiness scale. During our follow-up three months later, he remained well with no complications. DIAGNOSIS: We diagnosed the patient with narcolepsy type 2 according to the 3rd Edition of International Classification of Sleep Disorders (ICSD-3). CONCLUSION: The patient suffered from EDS and was diagnosed with narcolepsy type 2. The narcolepsy type 2 was linked to glioma of the hippocampus area. The hippocampus might be another part of regulating the sleep-arousal pathway, and the glioma secretion might interact with the orexin projection system.


Assuntos
Neoplasias Encefálicas/complicações , Glioma/complicações , Narcolepsia/etiologia , Lobo Temporal , Adulto , Humanos , Masculino , Narcolepsia/classificação
4.
Anticancer Res ; 40(6): 3429-3434, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32487641

RESUMO

BACKGROUND/AIM: Seizures are a serious condition for patients with brain metastases. Prevalence, risk factors and a potential association of seizures with survival prior to whole-brain irradiation (WBI) for cerebral metastases were retrospectively investigated. PATIENTS AND METHODS: In 1,934 patients, the prevalence of pre-treatment seizures (pre-WBI) was determined. Seven pre-treatment characteristics were evaluated for associations with seizures. Ten characteristics including pre-treatment symptoms (none vs. seizures only vs. seizures+others vs. others only) and seizures (yes vs. no) were analyzed for survival. RESULTS: In 251 patients (13.0%), pre-treatment seizures were documented. The occurrence of seizures was significantly associated with 1-3 brain metastases and lack of extra-cerebral spread. On multivariate analysis, age, gender, performance score, number of metastases and extra-cerebral spread were significantly associated with survival; pre-treatment symptoms and seizures showed associations on univariate but not on multivariate analyses. CONCLUSION: Few brain metastases and lack of extra-cerebral spread were independent risk factors for pre-treatment seizures. Seizures appeared positively associated with survival.


Assuntos
Neoplasias Encefálicas/complicações , Neoplasias Encefálicas/secundário , Convulsões/etiologia , Adulto , Idoso , Neoplasias Encefálicas/epidemiologia , Neoplasias Encefálicas/radioterapia , Irradiação Craniana , Feminino , Humanos , Estimativa de Kaplan-Meier , Masculino , Pessoa de Meia-Idade , Prevalência , Prognóstico , Modelos de Riscos Proporcionais , Dosagem Radioterapêutica , Medição de Risco , Fatores de Risco , Convulsões/diagnóstico , Convulsões/epidemiologia , Resultado do Tratamento
5.
Anticancer Res ; 40(6): 3499-3504, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32487650

RESUMO

BACKGROUND/AIM: Seizures represent a major problem for patients with brain metastases. This study evaluated the role of seizures in patients receiving single-fraction radiosurgery (SRS) or multi-fraction stereotactic radiotherapy (FSRT). PATIENTS AND METHODS: This retrospective study included 195 patients receiving SRS (n=164) or FSRT (n=31) alone for one to three brain metastases. The prevalence of pre-SRS/FSRT seizures and correlations with pre-treatment factors were investigated. These factors plus pre-SRS/FSRT seizures were assessed in regard to survival. RESULTS: Thirty-three patients had pre-SRS/FSRT seizures (prevalence=16.9%). Seizures were significantly correlated with age ≤61 years. Trends were observed for seizures being more frequent in those with NSCLC and those without extra-cranial metastatic spread. On multivariate analysis, significant associations with improved survival were found for Karnofsky performance score ≥80%, breast cancer, and an interval from diagnosis of malignant disease to SRS/FSRT ≥21 months. CONCLUSION: Younger age, NSCLC and absence of extra-cranial spread appeared to be risk factors for seizures prior to SRS/FSRT. Having seizures prior to SRS/FSRT showed no association with survival.


Assuntos
Neoplasias Encefálicas/complicações , Neoplasias Encefálicas/secundário , Radiocirurgia/efeitos adversos , Convulsões/etiologia , Adulto , Idoso , Neoplasias Encefálicas/mortalidade , Neoplasias Encefálicas/radioterapia , Fracionamento da Dose de Radiação , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Prognóstico , Modelos de Riscos Proporcionais , Radiocirurgia/métodos , Dosagem Radioterapêutica , Estudos Retrospectivos
11.
Nat Commun ; 11(1): 2659, 2020 05 27.
Artigo em Inglês | MEDLINE | ID: mdl-32461638

RESUMO

Cavernous angiomas (CA) are common vascular anomalies causing brain hemorrhage. Based on mouse studies, roles of gram-negative bacteria and altered intestinal homeostasis have been implicated in CA pathogenesis, and pilot study had suggested potential microbiome differences between non-CA and CA individuals based on 16S rRNA gene sequencing. We here assess microbiome differences in a larger cohort of human subjects with and without CA, and among subjects with different clinical features, and conduct more definitive microbial analyses using metagenomic shotgun sequencing. Relative abundance of distinct bacterial species in CA patients is shown, consistent with postulated permissive microbiome driving CA lesion genesis via lipopolysaccharide signaling, in humans as in mice. Other microbiome differences are related to CA clinical behavior. Weighted combinations of microbiome signatures and plasma inflammatory biomarkers enhance associations with disease severity and hemorrhage. This is the first demonstration of a sensitive and specific diagnostic microbiome in a human neurovascular disease.


Assuntos
Microbioma Gastrointestinal/genética , Hemangioma Cavernoso/complicações , Adolescente , Adulto , Biomarcadores/sangue , Neoplasias Encefálicas/complicações , Neoplasias Encefálicas/diagnóstico , Neoplasias Encefálicas/microbiologia , DNA Bacteriano/genética , Fezes/microbiologia , Feminino , Hemangioma Cavernoso/diagnóstico , Humanos , Intestinos/microbiologia , Intestinos/patologia , Masculino , Metagenômica , Pessoa de Meia-Idade , Projetos Piloto , RNA Ribossômico 16S/genética , Adulto Jovem
12.
PLoS One ; 15(5): e0233645, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32469944

RESUMO

Characterization of healthy versus pathological tissue in the peritumoral area is confounded by the presence of edema, making free water estimation the key concern in modeling tissue microstructure. Most methods that model tissue microstructure are either based on advanced acquisition schemes not readily available in the clinic or are not designed to address the challenge of edema. This underscores the need for a robust free water elimination (FWE) method that estimates free water in pathological tissue but can be used with clinically prevalent single-shell diffusion tensor imaging data. FWE in single-shell data requires the fitting of a bi-compartment model, which is an ill-posed problem. Its solution requires optimization, which relies on an initialization step. We propose a novel initialization approach for FWE, FERNET, which improves the estimation of free water in edematous and infiltrated peritumoral regions, using single-shell diffusion MRI data. The method has been extensively investigated on simulated data and healthy dataset. Additionally, it has been applied to clinically acquired data from brain tumor patients to characterize the peritumoral region and improve tractography in it.


Assuntos
Edema Encefálico/diagnóstico por imagem , Neoplasias Encefálicas/diagnóstico por imagem , Encéfalo/diagnóstico por imagem , Imagem de Difusão por Ressonância Magnética/métodos , Água/análise , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Algoritmos , Edema Encefálico/complicações , Neoplasias Encefálicas/complicações , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Adulto Jovem
13.
Pediatr Blood Cancer ; 67(7): e28379, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32383818

RESUMO

BACKGROUND: Hypothalamic obesity causes unrelenting weight gain for childhood brain tumor survivors. No single therapy has proven effective for treatment. We aimed to evaluate effectiveness of long-term methylphenidate therapy on body mass index (BMI) change in children with hypothalamic obesity. METHODS: A retrospective analysis included children with a history of brain tumor and hypothalamic obesity receiving methylphenidate (10-60 mg/day) for hypothalamic obesity. Subjects were evaluated for BMI trajectory before and after methylphenidate start. Given that z-scores can be skewed in severely obese children, we calculated BMI as a percent of the BMI at the 95th percentile for the child's age and gender (BMI% 95th). RESULTS: Twelve patients with hypothalamic obesity completed methylphenidate therapy for at least 6 months (median 3.1 years, range 1.0-5.8 years). All subjects had a suprasellar tumor (nine [75%] with craniopharyngioma) and pituitary dysfunction. Pretreatment median BMI percent of the 95th percentile was 125.6% (interquartile range [IQR] 25-75: 115.3-138.3%) with BMI z-score of 2.4 (IQR 25-75: 2.1-2.6). Following methylphenidate treatment, there was a 69.9% reduction in the median slope of BMI change. Eleven of 12 patients (92%) had a reduction in the slope of their BMI change on methylphenidate treatment. Postmethylphenidate median BMI percent of the 95th percentile decrease to 115.2% (IQR 25-75: 103.6-121.2%) with median BMI z-score of 2.1 (IQR 25-75: 1.8-2.2). Mild side effects were noted in six patients. CONCLUSIONS: Methylphenidate use reduced and sustained BMI change in children with hypothalamic obesity. Stimulant therapy is an effective first-line agent for treatment of hypothalamic obesity.


Assuntos
Neoplasias Encefálicas/complicações , Sobreviventes de Câncer/estatística & dados numéricos , Estimulantes do Sistema Nervoso Central/uso terapêutico , Doenças Hipotalâmicas/tratamento farmacológico , Metilfenidato/uso terapêutico , Obesidade/tratamento farmacológico , Perda de Peso/efeitos dos fármacos , Neoplasias Encefálicas/terapia , Criança , Pré-Escolar , Feminino , Seguimentos , Humanos , Doenças Hipotalâmicas/diagnóstico , Doenças Hipotalâmicas/etiologia , Masculino , Obesidade/diagnóstico , Obesidade/etiologia , Prognóstico , Estudos Retrospectivos
15.
World Neurosurg ; 139: 483-487, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32360731

RESUMO

BACKGROUND: Immuno-oncotherapy (IO) has revolutionized systemic cancer care but remains experimental in brain tumors. IO treatment risks multiorgan autoimmune inflammatory responses that limit its use. The central nervous system (CNS) is an immune-specialized compartment with restricted cellular access, thus fewer cases are reported for immune-mediated encephalitis. Interestingly, patients with history of blood-brain barrier compromise are potentially at higher risk for immune cell trafficking to the CNS. CASE DESCRIPTION: We report the first case, to our knowledge, of a 70-year-old man with clear cell renal cell carcinoma with pulmonary metastases treated with lung irradiation, nephrectomy, and chemotherapy prior to switching to single-agent nivolumab IO. The patient presented with new-onset generalized tonic-clonic seizure and left visual field-cut. Review of patient history revealed remote traumatic brain injury (TBI). Brain imaging noted a solid-enhancing right occipital mass that was presumed metastasis versus lymphoma. Cerebrospinal fluid cytology was negative for malignancy but concerning for lymphoproliferative process not determined to be malignant. The patient started steroids and anti-epileptic therapy. After negative systemic cancer re-staging, IO was discontinued and steroids were initiated with demonstrated patient clinical improvement. CONCLUSIONS: We concluded the diagnosis of immune-mediated encephalitis secondary to IO with collection of reactive T-cells within the area of encephalomalacia. The area of encephalomalacia from prior TBI served to compartmentalize the reactive lymphocytes, giving the appearance of a mass. Taken together, new onset seizure in patients on IO might signal encephalitis and CNS metastatic mimicry should be considered in patients with a prior history of TBI and encephalomalacia.


Assuntos
Antineoplásicos Imunológicos/efeitos adversos , Lesões Encefálicas Traumáticas/diagnóstico por imagem , Neoplasias Encefálicas/diagnóstico por imagem , Encefalite/induzido quimicamente , Encefalite/diagnóstico por imagem , Idoso , Lesões Encefálicas Traumáticas/complicações , Neoplasias Encefálicas/complicações , Neoplasias Encefálicas/secundário , Carcinoma de Células Renais/diagnóstico por imagem , Carcinoma de Células Renais/tratamento farmacológico , Carcinoma de Células Renais/secundário , Diagnóstico Diferencial , Encefalite/complicações , Humanos , Neoplasias Renais/diagnóstico por imagem , Neoplasias Renais/tratamento farmacológico , Neoplasias Renais/secundário , Neoplasias Pulmonares/diagnóstico por imagem , Neoplasias Pulmonares/tratamento farmacológico , Neoplasias Pulmonares/secundário , Masculino , Nivolumabe/efeitos adversos
19.
World Neurosurg ; 138: 349-351, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32229303

RESUMO

BACKGROUND: Intracranial arteriovenous malformations (AVMs) have been considered congenital. We present and discuss a case of a child who had no evidence of an AVM at 6 years of age when presenting with parenchymatous hemorrhage due to cavernous angioma and who developed the lesion during 10 years of follow-up. CASE DESCRIPTION: A 6-year-old female presented with parenchymatous hemorrhage and was diagnosed with cavernous angioma of the right occipital lobe. She was treated with lesion removal and remained asymptomatic during the initial follow-up. At age 16, she presented to the emergency department with a new-onset headache. A new magnetic resonance imaging scan was performed and revealed an AVM in the right temporal lobe, which was confirmed with digital subtraction angiography. The AVM had not been present 10 years earlier, as seen on the previous digital subtraction angiography and magnetic resonance imaging examinations. CONCLUSIONS: On the basis of recent findings of de novo AVMs and on the current theory of a postnatal origin of AVMs, we propose that AVMs cannot always be considered congenital and that several factors can contribute to their pathogenesis.


Assuntos
Fístula Arteriovenosa/patologia , Malformações Arteriovenosas Intracranianas/patologia , Fístula Arteriovenosa/complicações , Neoplasias Encefálicas/complicações , Neoplasias Encefálicas/cirurgia , Criança , Feminino , Hemangioma Cavernoso do Sistema Nervoso Central/complicações , Hemangioma Cavernoso do Sistema Nervoso Central/cirurgia , Humanos , Malformações Arteriovenosas Intracranianas/complicações
20.
Ann R Coll Surg Engl ; 102(5): e107-e110, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32233872

RESUMO

The brain is a particularly rare site of metastasis from papillary microcarcinoma, with only few cases described in the literature. We present a case of 59-year-old man who presented with seizures and dysphasia due to left frontal lobe cystic mass, which was excised and turned out on histopathology to be of thyroid origin. Total thyroidectomy was performed and histology showed multifocal papillary microcarcinoma with the largest focus of 3mm with no other adverse features. The patient had ablative radioactive iodine postoperatively, with subsequent exit scan showing no uptake in the brain. Follow-up brain magnetic resonance imaging showed continuous regression of the surgical cavity. Although rare, such cases should be aggressively treated and followed up over the long term, because of reported associated high mortality.


Assuntos
Neoplasias Encefálicas/diagnóstico , Carcinoma Papilar/diagnóstico , Procedimentos Neurocirúrgicos , Convulsões/etiologia , Neoplasias da Glândula Tireoide/patologia , Encéfalo/diagnóstico por imagem , Encéfalo/patologia , Encéfalo/cirurgia , Neoplasias Encefálicas/complicações , Neoplasias Encefálicas/secundário , Neoplasias Encefálicas/cirurgia , Carcinoma Papilar/secundário , Carcinoma Papilar/cirurgia , Humanos , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Glândula Tireoide/patologia , Glândula Tireoide/cirurgia , Neoplasias da Glândula Tireoide/diagnóstico , Neoplasias da Glândula Tireoide/secundário , Neoplasias da Glândula Tireoide/cirurgia , Tireoidectomia
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