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2.
Handb Clin Neurol ; 181: 75-115, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34238481

RESUMO

The concept of craniopharyngiomas (CPs) primarily affecting the hypothalamus, or "hypothalamic CPs" (Hy-CPs), refers, in a restrictive sense, to the subgroup of CPs originally developing within the neural tissue of the infundibulum and tuber cinereum, the components of the third ventricle floor. This subgroup, also known as infundibulo-tuberal CPs, largely occupies the third ventricle and comprises up to 40% of this pathological entity. The small subgroup of strictly intraventricular CPs (5%), lesions wholly developed within the third ventricle above an anatomically intact third ventricle floor, can also be included within the Hy-CP category. The remaining types of sellar and/or suprasellar CPs may compress or invade the hypothalamic region during their growth but will not be considered in this review. Hy-CPs predominantly affect adults, causing a wide range of symptoms derived from hypothalamic dysfunction, such as adiposogenital dystrophy (Babinski-Fröhlich's syndrome), diabetes insipidus (DI), abnormal diurnal somnolence, and a complex set of cognitive (dementia-like, Korsakoff-like), emotional (rage, apathy, depression), and behavioral (autism-like, psychotic-like) disturbances. Accordingly, Hy-CPs represent a neurobiological model of psychiatric disorders caused by a lesion restricted to the hypothalamus. The vast majority (90%) of squamous-papillary CPs belong to the Hy-CP category. Pathologically, most Hy-CPs present extensive and strong adhesions to the surrounding hypothalamus, usually formed of a thick band of gliotic tissue encircling the central portion of the tumor ("ring-like" attachment) or its entire boundary ("circumferential" attachment). CPs with these severe adhesion types associate high surgical risk, with morbidity and mortality rates three times higher than those for sellar/suprasellar CPs. Consequently, radical surgical removal of Hy-CPs cannot be generally recommended. Rather, Hy-CPs should be accurately classified according to an individualized surgery-risk stratification scheme considering patient age, CP topography, presence of hypothalamic symptoms, tumor size, and, most importantly, the CP-hypothalamus adhesion pattern.


Assuntos
Craniofaringioma , Neoplasias Hipofisárias , Adulto , Ventrículos Cerebrais , Humanos , Hipotálamo , Hipófise
3.
Aging (Albany NY) ; 13(12): 16816-16833, 2021 06 28.
Artigo em Inglês | MEDLINE | ID: mdl-34182541

RESUMO

BACKGROUND: Subarachnoid hemorrhage (SAH) is a life-threatening disease worldwide, and effective pharmaceutical treatment is still lacking. Celastrol is a plant-derived triterpene which showed neuroprotective potential in several types of brain insults. This study aimed to investigate the effects of celastrol on early brain injury (EBI) after SAH. METHODS: A total of sixty-one male Sprague-Dawley rats were used in this study. Rat SAH endovascular perforation model was established to mimic the pathological changes of EBI after SAH. Multiple methods such as 3.0T MRI scanning, immunohistochemistry, western blotting and propidium iodide (PI) labeling were used to explore the therapeutic effects of celastrol on SAH. RESULTS: Celastrol treatment attenuated SAH-caused brain swelling, reduced T2 lesion volume and ventricular volume in MRI scanning, and improved overall neurological score. Albumin leakage and the degradation of tight junction proteins were also ameliorated after celastrol administration. Celastrol protected blood-brain bairrer integrity through inhibiting MMP-9 expression and anti-neuroinflammatory effects. Additionally, necroptosis-related proteins RIP3 and MLKL were down-regulated and PI-positive cells in the basal cortex were less in the celastrol-treated SAH group than that in untreated SAH group. CONCLUSIONS: Celastrol exhibits neuroprotective effects on EBI after SAH and deserves to be further investigated as an add-on pharmaceutical therapy.


Assuntos
Barreira Hematoencefálica/patologia , Lesões Encefálicas/tratamento farmacológico , Lesões Encefálicas/etiologia , Necroptose/efeitos dos fármacos , Fármacos Neuroprotetores/uso terapêutico , Triterpenos Pentacíclicos/uso terapêutico , Hemorragia Subaracnóidea/complicações , Albuminas/metabolismo , Animais , Barreira Hematoencefálica/diagnóstico por imagem , Barreira Hematoencefálica/efeitos dos fármacos , Edema Encefálico/complicações , Edema Encefálico/diagnóstico por imagem , Edema Encefálico/tratamento farmacológico , Lesões Encefálicas/diagnóstico por imagem , Ventrículos Cerebrais/efeitos dos fármacos , Ventrículos Cerebrais/patologia , Regulação para Baixo/efeitos dos fármacos , Inflamação/patologia , Masculino , Metaloproteinase 9 da Matriz/metabolismo , Fármacos Neuroprotetores/farmacologia , Tamanho do Órgão/efeitos dos fármacos , Triterpenos Pentacíclicos/farmacologia , Proteínas Quinases/metabolismo , Ratos Sprague-Dawley , Proteína Serina-Treonina Quinases de Interação com Receptores/metabolismo , Transdução de Sinais/efeitos dos fármacos , Hemorragia Subaracnóidea/diagnóstico por imagem , Análise de Sobrevida , Junções Íntimas/efeitos dos fármacos , Junções Íntimas/metabolismo , Regulação para Cima/efeitos dos fármacos
4.
Science ; 372(6547): 1205-1209, 2021 06 11.
Artigo em Inglês | MEDLINE | ID: mdl-34112692

RESUMO

Quiescent neural stem cells (NSCs) in the adult mouse ventricular-subventricular zone (V-SVZ) undergo activation to generate neurons and some glia. Here we show that platelet-derived growth factor receptor beta (PDGFRß) is expressed by adult V-SVZ NSCs that generate olfactory bulb interneurons and glia. Selective deletion of PDGFRß in adult V-SVZ NSCs leads to their release from quiescence, uncovering gliogenic domains for different glial cell types. These domains are also recruited upon injury. We identify an intraventricular oligodendrocyte progenitor derived from NSCs inside the brain ventricles that contacts supraependymal axons. Together, our findings reveal that the adult V-SVZ contains spatial domains for gliogenesis, in addition to those for neurogenesis. These gliogenic NSC domains tend to be quiescent under homeostasis and may contribute to brain plasticity.


Assuntos
Células-Tronco Adultas/fisiologia , Ventrículos Cerebrais/fisiologia , Ventrículos Laterais/fisiologia , Células-Tronco Neurais/fisiologia , Neuroglia/fisiologia , Receptor beta de Fator de Crescimento Derivado de Plaquetas/metabolismo , Animais , Astrócitos/citologia , Astrócitos/fisiologia , Axônios/fisiologia , Diferenciação Celular , Divisão Celular , Ventrículos Cerebrais/citologia , Epêndima/citologia , Epêndima/fisiologia , Feminino , Perfilação da Expressão Gênica , Homeostase , Ventrículos Laterais/citologia , Masculino , Camundongos , Neurogênese , Bulbo Olfatório/citologia , Bulbo Olfatório/fisiologia , Oligodendroglia/citologia , Oligodendroglia/fisiologia , Receptor beta de Fator de Crescimento Derivado de Plaquetas/genética
6.
Aging (Albany NY) ; 13(9): 12833-12848, 2021 05 04.
Artigo em Inglês | MEDLINE | ID: mdl-33946042

RESUMO

We constructed a radiomics-clinical model to predict intraventricular hemorrhage (IVH) growth after spontaneous intracerebral hematoma. The model was developed using a training cohort (N=626) and validated with an independent testing cohort (N=270). Radiomics features and clinical predictors were selected using the least absolute shrinkage and selection operator (LASSO) method and multivariate analysis. The radiomics score (Rad-score) was calculated through linear combination of selected features multiplied by their respective LASSO coefficients. The support vector machine (SVM) method was used to construct the model. IVH growth was experienced by 13.4% and 13.7% of patients in the training and testing cohorts, respectively. The Rad-score was associated with severe IVH and poor outcome. Independent predictors of IVH growth included hypercholesterolemia (odds ratio [OR], 0.12 [95%CI, 0.02-0.90]; p=0.039), baseline Graeb score (OR, 1.26 [95%CI, 1.16-1.36]; p<0.001), time to initial CT (OR, 0.70 [95%CI, 0.58-0.86]; p<0.001), international normalized ratio (OR, 4.27 [95%CI, 1.40, 13.0]; p=0.011), and Rad-score (OR, 2.3 [95%CI, 1.6-3.3]; p<0.001). In the training cohort, the model achieved an AUC of 0.78, sensitivity of 0.83, and specificity of 0.66. In the testing cohort, AUC, sensitivity, and specificity were 0.71, 0.81, and 0.64, respectively. This radiomics-clinical model thus has the potential to predict IVH growth.


Assuntos
Hemorragia Cerebral Intraventricular/mortalidade , Ventrículos Cerebrais/diagnóstico por imagem , Hidrocefalia/diagnóstico , Hipercolesterolemia/epidemiologia , Processamento de Imagem Assistida por Computador/métodos , Idoso , Hemorragia Cerebral Intraventricular/sangue , Hemorragia Cerebral Intraventricular/complicações , Hemorragia Cerebral Intraventricular/diagnóstico , Estudos de Viabilidade , Feminino , Humanos , Hidrocefalia/sangue , Hidrocefalia/etiologia , Hidrocefalia/mortalidade , Hipercolesterolemia/sangue , Coeficiente Internacional Normatizado , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Curva ROC , Estudos Retrospectivos , Medição de Risco/métodos , Fatores de Risco , Índice de Gravidade de Doença , Máquina de Vetores de Suporte , Tomografia Computadorizada por Raios X
8.
BMJ Case Rep ; 14(4)2021 Apr 08.
Artigo em Inglês | MEDLINE | ID: mdl-33832938

RESUMO

Brain injury with ventricle puncture is a well-known complication of ventriculoperitoneal (VP) shunting. However, parenchymal injuries caused by a shunt tunneller are rare. Herein, we present a case of penetrating brain injury caused by a shunt tunneller during VP shunting. An 83-year-old woman with brainstem glioma underwent VP shunting to control hydrocephalus due to tumour growth. She underwent brainstem tumour biopsy with a lateral suboccipital approach. After the shunting, CT showed a linear haematoma in the left occipital lobe far from the site of the ventricular puncture. MRI revealed a small contusion in the left cerebellar hemisphere, disconnection of the left tentorial membrane and linear haematoma on a straight line. These facts suggested that the shunt tunneller had penetrated the skull through the craniotomy of the posterior fossa. This is a rare complication of VP shunting, with limited cases reported in the literature.


Assuntos
Glioma , Traumatismos Cranianos Penetrantes , Hidrocefalia , Idoso de 80 Anos ou mais , Ventrículos Cerebrais , Feminino , Humanos , Hidrocefalia/etiologia , Hidrocefalia/cirurgia , Derivação Ventriculoperitoneal/efeitos adversos
9.
Acta Neurochir Suppl ; 131: 207-210, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33839846

RESUMO

The intracranial pressure (ICP)-volume relationship contains important information for diagnosing hydrocephalus and other space-occupying pathologies. We aimed to design a new parameter which quantifies the relationship and can be calculated from overnight recordings.The new parameter, the respiratory amplitude quotient (RAQ), characterizes the modulation of the pulse amplitude by the respiratory wave in the ICP time course. RAQ is defined as the ratio of the amplitude of the respiratory wave in the ICP signal to the amplitude of the respiration-induced wave in the course of the heartbeat-dependent pulse amplitude.We tested RAQ on synthetically generated ICP waveforms and found a mean difference of <0.5% between the calculated values of RAQ and the theoretically determined values. We further extracted RAQ from datasets obtained by overnight recording in hydrocephalus patients with a stenosis of the aqueduct and a comparison group finding a significant difference between the RAQ values of either group.


Assuntos
Hidrocefalia , Pressão Intracraniana , Calibragem , Aqueduto do Mesencéfalo , Ventrículos Cerebrais , Humanos
10.
Neurol India ; 69(2): 446-450, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33904473

RESUMO

Background: Ventriculoperitoneal shunt (VPS) is the most common procedure used in the management of hydrocephalus regardless of the etiology. The standard free-hand technique is used for the placement of VPS in patients with enlarged ventricles. In patients with very small ventricles, CSF access through ventriculostomy becomes challenging and free-hand technique may be associated with high failure rates. In these situations, stereotactic-guided VPS becomes very useful. Objective: To validate and describe the technique of robotic-guided VPS in cases with very small ventricles. Methods: Three patients underwent VPS with robotic guidance between 2016 and 2019. One patient with a diagnosis of occipital meningocele, who later developed recalcitrant CSF leak from the operative site, and two other patients were diagnosed with idiopathic intracranial hypertension (IIH). Plain CT brain with 1-mm slice thickness acquired prior to the surgery was uploaded into the ROSA machine (Zimmer Biomet Warsaw, Indiana). The trajectory for the VPS is created on the robotic software presurgery. The patient is placed in the supine position with head turned to the side contralateral to VPS insertion and fixed with Mayfield clamp. Registration of the patient is done with the robot. The placement of the VPS is commenced with the robotic arm in the predetermined trajectory. Results: Ventricle was hit in a single attempt in all the cases. CSF leak stopped in the case with meningocele; headache, and visual acuity improved in both the cases of IIH. Conclusion: Robotic-guidance provides a safe and accurate method of VPS placement even in the presence of slit-like ventricles.


Assuntos
Hidrocefalia , Robótica , Ventrículos Cerebrais/diagnóstico por imagem , Ventrículos Cerebrais/cirurgia , Humanos , Hidrocefalia/cirurgia , Resultado do Tratamento , Derivação Ventriculoperitoneal , Ventriculostomia
11.
Genes Cells ; 26(6): 399-410, 2021 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-33811429

RESUMO

An expanded and folded neocortex is characteristic of higher mammals, including humans and other primates. The neocortical surface area was dramatically enlarged during the course of mammalian brain evolution from lissencephalic to gyrencephalic mammals, and this bestowed higher cognitive functions especially to primates, including humans. In this study, we generated transgenic (Tg) mice in which the expression of Sonic hedgehog (Shh) could be controlled in neural stem cells (NSCs) and neural progenitors by using the Tet-on system. Shh overexpression during embryogenesis promoted the symmetric proliferative division of NSCs in the neocortical region, leading to the expansion of lateral ventricles and tangential extension of the ventricular zone. Moreover, Shh-overexpressing Tg mice showed dramatic expansion of the neocortical surface area and exhibited a wrinkled brain when overexpression was commenced at early stages of neural development. These results indicate that Shh is able to increase the neocortical NSCs and contribute to expansion of the neocortex.


Assuntos
Proteínas Hedgehog/metabolismo , Neocórtex/metabolismo , Células-Tronco Neurais/citologia , Células-Tronco Neurais/metabolismo , Animais , Biomarcadores/metabolismo , Diferenciação Celular , Proliferação de Células , Ventrículos Cerebrais/metabolismo , Regulação da Expressão Gênica , Camundongos Transgênicos , Neurônios/citologia , Transdução de Sinais
12.
West J Emerg Med ; 22(2): 379-388, 2021 Jan 12.
Artigo em Inglês | MEDLINE | ID: mdl-33856326

RESUMO

INTRODUCTION: Patients with spontaneous intracranial hemorrhage (sICH) are associated with high mortality and require early neurosurgical interventions. At our academic referral center, the neurocritical care unit (NCCU) receives patients directly from referring facilities. However, when no NCCU bed is immediately available, patients are initially admitted to the critical care resuscitation unit (CCRU). We hypothesized that the CCRU expedites transfer of sICH patients and facilitates timely external ventricular drain (EVD) placement comparable to the NCCU. METHODS: This is a pre-post study of adult patients transferred with sICH and EVD placement. Patients admitted between January 2011-July 2013 (2011 Control) were compared with patients admitted either to the CCRU or the NCCU (2013 Control) between August 2013-September 2015. The primary outcome was time interval from arrival at any intensive care units (ICU) to time of EVD placement (ARR-EVD). Secondary outcomes included time interval from emergency department transfer request to arrival, and in-hospital mortality. We assessed clinical association by multivariable logistic regressions. RESULTS: We analyzed 259 sICH patients who received EVDs: 123 (48%) CCRU; 81 (31%) 2011 Control; and 55 (21%) in the 2013 Control. The groups had similar characteristics, age, disease severity, and mortality. Median ARR-EVD time was 170 minutes [106-311] for CCRU patients; 241 minutes [152-490] (p < 0.01) for 2011 Control; and 210 minutes [139-574], p = 0.28) for 2013 Control. Median transfer request-arrival time for CCRU patients was significantly less than both control groups. Multivariable logistic regression showed each minute delay in ARR-EVD was associated with 0.03% increased likelihood of death (odds ratio 1.0003, 95% confidence interval, 1.0001-1.006, p = 0.043). CONCLUSION: Patients admitted to the CCRU had shorter transfer times when compared to patients admitted directly to other ICUs. Compared to the specialty NCCU, the CCRU had similar time interval from arrival to EVD placement. A resuscitation unit like the CCRU can complement the specialty unit NCCU in caring for patients with sICH who require EVDs.


Assuntos
Drenagem/métodos , Serviço Hospitalar de Emergência/organização & administração , Unidades de Terapia Intensiva/estatística & dados numéricos , Hemorragias Intracranianas , Tempo para o Tratamento , Ventrículos Cerebrais/cirurgia , Feminino , Mortalidade Hospitalar , Humanos , Hemorragias Intracranianas/mortalidade , Hemorragias Intracranianas/terapia , Masculino , Maryland/epidemiologia , Pessoa de Meia-Idade , Transferência de Pacientes/métodos , Transferência de Pacientes/normas , Melhoria de Qualidade , Encaminhamento e Consulta/organização & administração , Estudos Retrospectivos , Tempo para o Tratamento/organização & administração , Tempo para o Tratamento/normas
13.
World Neurosurg ; 151: e1-e9, 2021 07.
Artigo em Inglês | MEDLINE | ID: mdl-33737257

RESUMO

BACKGROUND: For aSAH patients with external ventricular drainage (EVD) because of hydrocephalus, the consensus on application of CSF drainage from the lumbar cistern is mixed owing to concerns about its safety and questionable effectiveness. This study evaluated the additional effectiveness of CSF drainage from the lumbar cistern in aSAH patients with EVD. METHODS: This was a retrospective and observational study of adult patients with aSAH who were admitted to the intensive care unit at the Wuhan Union Hospital between June 2018 and June 2019. Three aSAH patients with EVD and serial lumbar punctures (LPs) were selected for comparison of CSF components. Four more aSAH patients who underwent divergent CSF drainage were selected to profile the additional effectiveness of lumbar cistern drainage in aSAH patients with EVD. RESULTS: Cases 1-3 with EVD and serial LPs showed dramatically higher red blood cell (RBC) and leukocyte counts with steeper changing curve in the lumbar cistern CSF than in the ventricle CSF. Case 5 had EVD alone and showed a slower clearing rate of blood clot in subarachnoid space compared with case 1. Case 4, with serial LPs alone, showed a steep changing curve of both RBC and leukocyte counts in the lumbar cistern CSF. Cases 6 and 7, with EVD and follow-up LPs, showed dramatically higher RBC and leukocyte counts in the lumbar cistern CSF than in the ventricle CSF after almost 2 weeks of EVD. CONCLUSIONS: For aSAH patients with EVD, serial LPs can accelerate clearance of toxic products from the subarachnoid space.


Assuntos
Ventrículos Cerebrais , Hidrocefalia/cirurgia , Procedimentos Neurocirúrgicos/métodos , Punção Espinal/métodos , Hemorragia Subaracnóidea/cirurgia , Adulto , Idoso , Cuidados Críticos , Drenagem , Contagem de Eritrócitos , Feminino , Humanos , Hidrocefalia/líquido cefalorraquidiano , Contagem de Leucócitos , Masculino , Meningites Bacterianas/líquido cefalorraquidiano , Meningites Bacterianas/diagnóstico , Pessoa de Meia-Idade , Procedimentos Neurocirúrgicos/efeitos adversos , Estudos Retrospectivos , Punção Espinal/efeitos adversos , Hemorragia Subaracnóidea/líquido cefalorraquidiano , Hemorragia Subaracnóidea/diagnóstico por imagem , Tomografia Computadorizada por Raios X , Resultado do Tratamento , Ventriculostomia
14.
No Shinkei Geka ; 49(2): 294-300, 2021 Mar.
Artigo em Japonês | MEDLINE | ID: mdl-33762450

RESUMO

High-resolution magnetic resonance imaging has made it possible to examine the normal anatomy, variations, and diseases of the lateral ventricles more precisely. Better understanding of the anatomic variations and lesions of the ventricular system helps to prevent erroneous interpretation of normal variants or lesions without clinical significance. We review the anatomy and tumors of the lateral ventricles in this article.


Assuntos
Ventrículos Laterais , Imageamento por Ressonância Magnética , Ventrículos Cerebrais/diagnóstico por imagem , Humanos , Ventrículos Laterais/diagnóstico por imagem
15.
No Shinkei Geka ; 49(2): 317-327, 2021 Mar.
Artigo em Japonês | MEDLINE | ID: mdl-33762452

RESUMO

Hydrocephalus is caused by excessive accumulation of cerebrospinal fluid(CSF)in the ventricles or the skull. Unlike acute hydrocephalus presenting with elevated intracranial pressure, chronic hydrocephalus is called normal-pressure hydrocephalus(NPH). Because the CSF volume increases slowly, the brain compressively deforms without increasing intracranial pressure. NPH should be diagnosed and treated according to the following three categories: idiopathic NPH(iNPH), secondary NPH(sNPH), and congenital NPH(cNPH). The intracranial CSF distribution in iNPH differed from that in sNPH or cNPH. In iNPH, the Sylvian fissure and basal cistern were conspicuously enlarged, whereas the convexity subarachnoid space was severely decreased. CSF distribution in the subarachnoid space specific to iNPH is known as "disproportionately enlarged subarachnoid space hydrocephalus(DESH)," which might be due to direct CSF communication between the lateral ventricles and the basal cistern at the inferior choroidal point of the choroidal fissure. After shunt surgery in a patient with NPH, the lateral ventricles and Sylvian fissure shrank from top to bottom, while the convexity subarachnoid space expanded. In NPH, except for obstructive hydrocephalus, the flow void sign on spin-echo T2-weighted images is usually observed around the aqueduct, which reflects the increased CSF movement.


Assuntos
Hidrocefalia de Pressão Normal , Hidrocefalia , Ventrículos Cerebrais/diagnóstico por imagem , Ventrículos Cerebrais/cirurgia , Derivações do Líquido Cefalorraquidiano , Humanos , Hidrocefalia/diagnóstico por imagem , Hidrocefalia/cirurgia , Hidrocefalia de Pressão Normal/diagnóstico por imagem , Hidrocefalia de Pressão Normal/cirurgia , Imageamento por Ressonância Magnética , Proteínas de Membrana , Proteínas do Tecido Nervoso , Espaço Subaracnóideo/cirurgia
16.
Neurology ; 96(14): e1865-e1875, 2021 04 06.
Artigo em Inglês | MEDLINE | ID: mdl-33737372

RESUMO

OBJECTIVES: To explore in vivo innate immune cell activation as a function of the distance from ventricular CSF in patients with multiple sclerosis (MS) using [18F]-DPA714 PET and to investigate its relationship with periventricular microstructural damage, evaluated by magnetization transfer ratio (MTR), and with trajectories of disability worsening. METHODS: Thirty-seven patients with MS and 19 healthy controls underwent MRI and [18F]-DPA714 TSPO dynamic PET, from which individual maps of voxels characterized by innate immune cell activation (DPA+) were generated. White matter (WM) was divided in 3-mm-thick concentric rings radiating from the ventricular surface toward the cortex, and the percentage of DPA+ voxels and mean MTR were extracted from each ring. Two-year trajectories of disability worsening were collected to identify patients with and without recent disability worsening. RESULTS: The percentage of DPA+ voxels was higher in patients compared to controls in the periventricular WM (p = 6.10e-6) and declined with increasing distance from ventricular surface, with a steeper gradient in patients compared to controls (p = 0.001). This gradient was found in both periventricular lesions and normal-appearing WM. In the total WM, it correlated with a gradient of microstructural tissue damage measured by MTR (r s = -0.65, p = 1.0e-3). Compared to clinically stable patients, patients with disability worsening were characterized by a higher percentage of DPA+ voxels in the periventricular normal-appearing WM (p = 0.025). CONCLUSIONS: Our results demonstrate that in MS the innate immune cell activation predominates in periventricular regions and is associated with microstructural damage and disability worsening. This could result from the diffusion of proinflammatory CSF-derived factors into surrounding tissues.


Assuntos
Córtex Cerebral/imunologia , Córtex Cerebral/patologia , Esclerose Múltipla/imunologia , Esclerose Múltipla/patologia , Substância Branca/imunologia , Substância Branca/patologia , Adulto , Ventrículos Cerebrais/imunologia , Ventrículos Cerebrais/patologia , Feminino , Humanos , Interpretação de Imagem Assistida por Computador , Masculino , Pessoa de Meia-Idade , Tomografia por Emissão de Pósitrons
17.
BMJ Case Rep ; 14(2)2021 Feb 09.
Artigo em Inglês | MEDLINE | ID: mdl-33563669

RESUMO

Primary intraventricular haemorrhage (PIVH) is an uncommon type of intracerebral haemorrhage, accounting for only 0.31% of all strokes and 3.1% of all intracerebral haemorrhages. Due to the low incidence of PIVH, little is known about its clinical characteristics, risk factors, aetiologies, prognosis and treatment. Acute hydrocephalus is common and is associated with a poor prognosis. External ventricular drainage (EVD) could promptly reduce intracranial pressure by diverting cerebrospinal fluid and intraventricular blood; however, the incidence of complications such as central nervous system infection, catheter occlusion and rebleeding are relatively common. Despite being an invasive procedure, frontal minicraniotomy is an available therapeutic option to avoid complications of EVD. The authors report a case of a PIVH managed with frontal minicraniotomy and perform a literature review about epidemiological data, clinical features and treatment of PIVH.


Assuntos
Hemorragia Cerebral/diagnóstico por imagem , Hemorragia Cerebral/cirurgia , Ventrículos Cerebrais , Craniotomia/métodos , Adulto , Drenagem/métodos , Humanos , Masculino
18.
Comput Biol Med ; 131: 104268, 2021 04.
Artigo em Inglês | MEDLINE | ID: mdl-33639351

RESUMO

Preterm neonates are highly likely to suffer from ventriculomegaly, a dilation of the Cerebral Ventricular System (CVS). This condition can develop into life-threatening hydrocephalus and is correlated with future neuro-developmental impairments. Consequently, it must be detected and monitored by physicians. In clinical routing, manual 2D measurements are performed on 2D ultrasound (US) images to estimate the CVS volume but this practice is imprecise due to the unavailability of 3D information. A way to tackle this problem would be to develop automatic CVS segmentation algorithms for 3D US data. In this paper, we investigate the potential of 2D and 3D Convolutional Neural Networks (CNN) to solve this complex task and propose to use Compositional Pattern Producing Network (CPPN) to enable Fully Convolutional Networks (FCN) to learn CVS location. Our database was composed of 25 3D US volumes collected on 21 preterm nenonates at the age of 35.8±1.6 gestational weeks. We found that the CPPN enables to encode CVS location, which increases the accuracy of the CNNs when they have few layers. Accuracy of the 2D and 3D FCNs reached intraobserver variability (IOV) in the case of dilated ventricles with Dice of 0.893±0.008 and 0.886±0.004 respectively (IOV = 0.898±0.008) and with volume errors of 0.45±0.42 cm3 and 0.36±0.24 cm3 respectively (IOV = 0.41±0.05 cm3). 3D FCNs were more accurate than 2D FCNs in the case of normal ventricles with Dice of 0.797±0.041 against 0.776±0.038 (IOV = 0.816±0.009) and volume errors of 0.35±0.29 cm3 against 0.35±0.24 cm3 (IOV = 0.2±0.11 cm3). The best segmentation time of volumes of size 320×320×320 was obtained by a 2D FCN in 3.5±0.2 s.


Assuntos
Imageamento Tridimensional , Redes Neurais de Computação , Algoritmos , Ventrículos Cerebrais/diagnóstico por imagem , Humanos , Processamento de Imagem Assistida por Computador , Lactente , Recém-Nascido , Ultrassonografia
19.
Ann Neurol ; 89(4): 813-822, 2021 04.
Artigo em Inglês | MEDLINE | ID: mdl-33527515

RESUMO

OBJECTIVE: Perinatal intracranial hemorrhage (pICH) is a rare event that occurs during the fetal/neonatal period with potentially devastating neurological outcome. However, the etiology of pICH is frequently hard to depict. We investigated the role of rare genetic variations in unexplained cases of pICH. METHODS: We performed whole-exome sequencing (WES) in fetuses and term neonates with otherwise unexplained pICH and their parents. Variant causality was determined according to the American College of Medical Genetics and Genomics (ACMG) criteria, consistency between suggested genes and phenotypes, and mode of inheritance. RESULTS: Twenty-six probands (25 families) were included in the study (9 with a prenatal diagnosis and 17 with a postnatal diagnosis). Intraventricular hemorrhage (IVH) was the most common type of hemorrhage (n = 16, 62%), followed by subpial (n = 4, 15%), subdural (n = 4, 15%), and parenchymal (n = 2, 8%) hemorrhage. Causative/likely causative variants were found in 4 subjects from 3 of the 25 families (12%) involving genes related to the brain microenvironment (COL4A1, COL4A2, and TREX-1). Additionally, potentially causative variants were detected in genes related to coagulation (GP1BA, F11, Von Willebrand factor [VWF], FGA, and F7; n = 4, 16%). A potential candidate gene for phenotypic expansion related to microtubular function (DNAH5) was identified in 1 case (4%). Fifty-five percent of the variants were inherited from an asymptomatic parent. Overall, these findings showed a monogenic cause for pICH in 12% to 32% of the families. INTERPRETATION: Our findings reveal a clinically significant diagnostic yield of WES in apparently idiopathic pICH and support the use of WES in the evaluation of these cases. ANN NEUROL 2021;89:813-822.


Assuntos
Hemorragias Intracranianas/etiologia , Hemorragias Intracranianas/genética , Adulto , Química Encefálica/genética , Ventrículos Cerebrais , DNA/genética , Exoma , Feminino , Feto , Variação Genética , Genótipo , Humanos , Recém-Nascido , Hemorragias Intracranianas/diagnóstico por imagem , Imageamento por Ressonância Magnética , Masculino , Fenótipo , Gravidez , Diagnóstico Pré-Natal , Sequenciamento Completo do Exoma
20.
J Neurosci ; 41(15): 3301-3306, 2021 04 14.
Artigo em Inglês | MEDLINE | ID: mdl-33597270

RESUMO

Heterogeneity is defined as the quality or state of being diverse in character or content. This article summarizes the natural progression from my studies, reported in the first issue of the Journal of Neuroscience, that identified molecular heterogeneity in precursor cells of the developing primate cerebral cortex to the current state in which differences defined at the molecular, cellular, circuit, and systems levels are building data encyclopedias. The emphasis on heterogeneity has impacted many contributors in the field of developmental neuroscience, who have led a quest to determine the extent to which there is diversity, when it appears developmentally, and what heritable and nonheritable factors mediate nervous system assembly and function. Since the appearance of the article on progenitor cell heterogeneity in the inaugural issue of the Journal of Neuroscience, there have been continuous advances in technologies and data analytics that are contributing to a much better understanding of the origins of neurobiological and behavioral heterogeneity.


Assuntos
Ventrículos Cerebrais/citologia , Células-Tronco Neurais/fisiologia , Neurogênese , Neuroglia/fisiologia , Animais , Ventrículos Cerebrais/crescimento & desenvolvimento , Ventrículos Cerebrais/fisiologia , Humanos , Células-Tronco Neurais/citologia , Neuroglia/citologia
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