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1.
J Clin Neurosci ; 93: 213-220, 2021 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-34656250

RESUMO

OBJECTIVES: Impending respiratory failure is catastrophic neurological deterioration caused by repeated c of a brainstem cavernous malformation (BSCM). The benefit and outcome prediction of acute surgery for this fatal condition is rarely reported. In this study, the authors reported a case series of acute surgical treatment (≤3 weeks after the last hemorrhagic episode) for the BSCM with impending respiratory failure and reviewed literature over the past 20 years. MATERIALS AND METHODS: Clinical and outcome data from 6 consecutive acute surgically-treated BSCM patients were analyzed. Intracerebral hemorrhage (ICH) scores, primary pontine hemorrhage (PPH) scores, and Lawton's BSCM grading were applied for surgical outcome prediction. Ten related articles were included for the literature review. RESULTS: There were three men and three women, with a mean age of 32.2 ± 9.3 years (range 15-45 years). The BSCMs were located at the pons in 5 cases and the medulla in 1 case. The ICH score was 1-2 in all cases, while the PPH score was 0 in all pontine BSCMs. For Lawton's BSCM grading, 3 cases were grade 2, 2 cases were grade 3, and 1 case was grade 1. All patients achieved spontaneous respiratory dysfunction relief postoperatively and significantly improved at follow-up (mean 4.47 ± 0.24 years;range4.0-5.6 years). CONCLUSIONS: Repeated hemorrhagic BSCM with impending respiratory failure can benefit from acute surgical treatment. The ICH score, PPH score, and Lawton's BSCM grading are promisingly useful tools for fast and efficient surgical outcome prediction.


Assuntos
Hemangioma Cavernoso do Sistema Nervoso Central , Insuficiência Respiratória , Adolescente , Adulto , Hemorragia Cerebral/complicações , Hemorragia Cerebral/diagnóstico por imagem , Feminino , Hemangioma Cavernoso do Sistema Nervoso Central/complicações , Hemangioma Cavernoso do Sistema Nervoso Central/diagnóstico por imagem , Hemangioma Cavernoso do Sistema Nervoso Central/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Procedimentos Neurocirúrgicos , Ponte/diagnóstico por imagem , Ponte/cirurgia , Insuficiência Respiratória/etiologia , Estudos Retrospectivos , Resultado do Tratamento , Adulto Jovem
2.
BMJ Case Rep ; 14(9)2021 Sep 03.
Artigo em Inglês | MEDLINE | ID: mdl-34479896

RESUMO

Eight-and-a-half syndrome is a rare entity characterised by conjugate horizontal gaze palsy, ipsilateral internuclear ophthalmoplegia and ipsilateral lower motor neuron type facial palsy. It is due to a lesion affecting median longitudinal fasciculus, paramedian pontine reticular formation and facial nerve fascicle on the same side at the level of pons. The diagnosis is easily missed as it needs detailed ocular movement examination. It is mainly caused due to infarction or demyelinating conditions. We are reporting an interesting case of a 54-year-old man with right-side eight-and-a-half syndrome due to acute ischaemic stroke and ST-elevation myocardial infarction of the inferior wall.


Assuntos
Isquemia Encefálica , Paralisia Facial , Transtornos da Motilidade Ocular , Oftalmoplegia , Acidente Vascular Cerebral , Paralisia Facial/etiologia , Humanos , Masculino , Pessoa de Meia-Idade , Transtornos da Motilidade Ocular/diagnóstico , Transtornos da Motilidade Ocular/etiologia , Oftalmoplegia/diagnóstico , Oftalmoplegia/etiologia , Ponte/diagnóstico por imagem , Acidente Vascular Cerebral/diagnóstico , Acidente Vascular Cerebral/etiologia
3.
Biomed Res Int ; 2021: 9956609, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34527746

RESUMO

Objective: Schizencephaly is a rare congenital malformation that causes motor impairment. To determine the treatment strategy, each domain of the motor functions should be appropriately evaluated. We correlated a color map of diffusion tensor imaging (DTI) and transcranial magnetic stimulation (TMS) with the hand function test (HFT) to identify the type of hand function that each test (DTI and TMS) reflects. Further, we attempted to demonstrate the motor neuron organization in schizencephaly. Method: This retrospective study was conducted on 12 patients with schizencephaly. TMS was conducted in the first dorsal interosseous (FDI), biceps (BB), and deltoid muscles of the upper extremity, and contralateral MEP (cMEP) and ipsilateral MEP (iMEP) were recorded. The HFT included the grip strength, box and block (B&B), and 9-hole peg test. The schizencephalic cleft was confirmed using magnetic resonance imaging, and the corticospinal tract (CST) was identified using the color map of DTI. The symmetry indices for the peduncle and CST at pons level were calculated as the ratios of the cross-sectional area of the less-affected side and that of the more-affected side. Result: In the more-affected hemisphere TMS, no iMEP was obtained. In the less-affected hemisphere TMS, the iMEP response was detected in 9 patients and cMEP in all patients, which was similar to the pattern observed in unilateral lesion. Paretic hand grip strength was strongly correlated with the presence of iMEP (p = 0.044). The symmetry index of the color map of DTI was significantly correlated with the B&B (p = 0.008, R 2 = 0.416), whereas the symmetry index of the peduncle was not correlated with all HFTs. Conclusion: In patients with schizencephaly, the iMEP response rate is correlated with the hand function related to strength, while the symmetricity of the CST by the color map of DTI is correlated with the hand function associated with dexterity. Additionally, we suggest the possible motor organization pattern of schizencephaly following interhemispheric competition.


Assuntos
Pedúnculo Cerebral/patologia , Mãos/fisiopatologia , Córtex Motor/patologia , Ponte/patologia , Transtornos Psicomotores/patologia , Tratos Piramidais/patologia , Esquizencefalia/patologia , Adolescente , Adulto , Mapeamento Encefálico , Pedúnculo Cerebral/diagnóstico por imagem , Pedúnculo Cerebral/fisiopatologia , Criança , Pré-Escolar , Imagem de Tensor de Difusão/métodos , Feminino , Força da Mão/fisiologia , Humanos , Masculino , Pessoa de Meia-Idade , Córtex Motor/diagnóstico por imagem , Córtex Motor/fisiopatologia , Músculo Esquelético/inervação , Músculo Esquelético/fisiopatologia , Ponte/diagnóstico por imagem , Ponte/fisiopatologia , Transtornos Psicomotores/diagnóstico por imagem , Transtornos Psicomotores/fisiopatologia , Tratos Piramidais/diagnóstico por imagem , Tratos Piramidais/fisiopatologia , Estudos Retrospectivos , Esquizencefalia/diagnóstico por imagem , Esquizencefalia/fisiopatologia , Estimulação Magnética Transcraniana/métodos
4.
BMJ Case Rep ; 14(7)2021 Jul 22.
Artigo em Inglês | MEDLINE | ID: mdl-34301695

RESUMO

A 64-year-old man from nursing home with a pontine stroke 3 months ago, ventilator-dependent, presented with episodic fever, tachycardia and tachypnoea occurring several times a day. He was evaluated for sepsis and pulmonary embolism and was treated empirically with broad-spectrum antibiotics. But these episodes persisted. Due to the episodic nature and typical symptoms of sympathetic overactivity, in the setting of prior brain injury, paroxysmal sympathetic hyperactivity was considered. His antibiotics were discontinued, and he was treated symptomatically with baclofen and bromocriptine, which resulted in a partial reduction of these episodes.


Assuntos
Doenças do Sistema Nervoso Autônomo , Sepse , Acidente Vascular Cerebral , Baclofeno , Humanos , Masculino , Pessoa de Meia-Idade , Ponte , Sepse/complicações , Sepse/diagnóstico , Sepse/tratamento farmacológico , Acidente Vascular Cerebral/complicações
6.
Neurol India ; 69(3): 729-732, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34169877

RESUMO

Choroid plexus papillomas (CPP) are commonly seen in the supratentorial compartment in children and only very rarely in the posterior fossa. CPP in the cerebello-pontine angle and cerebello-medullary fissure (CPA) in the pediatric age group are extremely rare with only seven previous cases reported in literature. The authors present the case of a 7-year-old girl who presented with neck tilt, imbalance, and headache. The MRI showed a lesion with a frond-like appearance in the CPA with heterogeneous enhancement. The tumor was excised radically using a cerebello-medullary fissure approach. The authors review and analyze the literature on this rare pediatric tumor, with specific attention to radiology and the surgical aspects.


Assuntos
Papiloma do Plexo Corióideo , Ângulo Cerebelopontino/diagnóstico por imagem , Ângulo Cerebelopontino/cirurgia , Criança , Feminino , Humanos , Imageamento por Ressonância Magnética , Papiloma do Plexo Corióideo/diagnóstico por imagem , Papiloma do Plexo Corióideo/cirurgia , Ponte , Radiografia
7.
J Vis Exp ; (171)2021 05 29.
Artigo em Inglês | MEDLINE | ID: mdl-34125085

RESUMO

We provide a protocol to establish a massive pontine hemorrhage model in a rat. Rats weighing about 250 grams were used in this study. One hundred microliters of autologous blood was taken from the tail vein and stereotaxically injected into the pons. The injection process was divided into 2 steps: First, 10 µL of blood was injected into a specific location, anteroposterior position (AP) -9.0 mm; lateral (Lat) 0 mm; vertical (Vert) -9.2 mm, followed by a second injection of the residual blood located at AP -9.0 mm; Lat 0 mm; Vert -9.0 mm with a 20-minute interval. The balance beam test, limb placement test, and the modified Voestch neuroscore were used to evaluate neurological function. Magnetic Resonance Imaging (MRI) was used to assess the volume of hemorrhage in vivo. The symptoms of this model were in line with patients with massive pontine hemorrhage.


Assuntos
Hemorragia Cerebral , Ponte , Animais , Hemorragia Cerebral/diagnóstico por imagem , Humanos , Imageamento por Ressonância Magnética , Ponte/diagnóstico por imagem , Ratos
8.
BMC Neurol ; 21(1): 204, 2021 May 20.
Artigo em Inglês | MEDLINE | ID: mdl-34016062

RESUMO

BACKGROUND: Since the nineteenth century, a great variety of crossed brainstem syndromes (CBS) have been described in the medical literature. A CBS typically combines ipsilateral cranial nerves deficits to contralateral long tracts involvement such as hemiparesis or hemianesthesia. Classical CBS seem in fact not to be so clear-cut entities with up to 20% of patients showing different or unnamed combinations of crossed symptoms. In terms of etiologies, acute brainstem infarction predominates but CBS secondary to hemorrhage, neoplasm, abscess, and demyelination have been described. The aim of this study was to assess the proportion of CBS caused by a bleeding episode arising from a brainstem cavernous malformation (BCM) reported in the literature. CASE PRESENTATION: We present the case of a typical Foville syndrome in a 65-year-old man that was caused by a pontine BCM with extralesional bleeding. Following the first bleeding episode, a conservative management was decided but the patient had eventually to be operated on soon after the second bleeding event. DISCUSSION: A literature review was conducted focusing on the five most common CBS (Benedikt, Weber, Foville, Millard-Gubler, Wallenberg) on Medline database from inception to 2020. According to the literature, hemorrhagic BCM account for approximately 7 % of CBS. Microsurgical excision may be indicated after the second bleeding episode but needs to be carefully weighted up against the risks of the surgical procedure and openly discussed with the patient. CONCLUSIONS: In the setting of a CBS, neuroimaging work-up may not infrequently reveal a BCM requiring complex multidisciplinary team management including neurosurgical advice.


Assuntos
Infartos do Tronco Encefálico , Tronco Encefálico , Hemorragia Cerebral , Hemangioma Cavernoso do Sistema Nervoso Central , Idoso , Tronco Encefálico/diagnóstico por imagem , Tronco Encefálico/fisiopatologia , Tronco Encefálico/cirurgia , Humanos , Masculino , Neuroimagem , Ponte/diagnóstico por imagem , Ponte/fisiopatologia , Ponte/cirurgia
9.
Oper Neurosurg (Hagerstown) ; 21(1): E26-E27, 2021 06 15.
Artigo em Inglês | MEDLINE | ID: mdl-34009381

RESUMO

The pons is the most frequent local for brain stem cavernoma.1 Repeated hemorrhage of brainstem cavernoma is associated with significant and accumulative neurological deficits and thus requires treatment. According to the Swedish Karolinska's group of radiosurgery, "it could not be concluded whether GKRS affects the natural course of a CM. The incidence of radiation-induced complications was approximately seven times higher than that expected."2 Thus, microsurgical removal has become the mainstay of treatment. In our experience, the following details assist in obtaining favorable outcomes and avoiding postoperative complications3,4: (a) the entry into the cavernoma based on thorough knowledge of the microanatomy; (b) the detailed study of the images and the presentation of the cavernoma on or near the brain stem surface; (c) the resection of the live cavernous hemangioma and not the mere removal of the multiple aged organized hematomas; (d) the preservation of the associated venous angioma; (e) the direct and shortest access to the lesion provided by a skull base approach; and (f) the use of the available technology, such as intraoperative neuromonitoring and neuroimaging. We present the case of a 54-yr-old male with recent deterioration in year 2001, past repetitive episodes of gait imbalance, and speech difficulty over a 7-yr period from known pontine cavernoma. The anterior petrosal approach provided superb and direct exposure to the entry at the lateral pons and the cavernoma was totally removed with preservation of the venous angioma. His preoperative neurological deficit rapidly recovered. Patient consented to the procedure and photography. Images at 3:15 from Kadri et al, The anatomical basis for surgical presercation of temporal muscle. J Neurosurg. 2004;100:517-522, used with permission from JNSPG. Image at 3:27 from Al-Mefty O, Operative Atlas of Meningiomas, © LWW, 1997, with permission.


Assuntos
Neoplasias do Tronco Encefálico , Hemangioma Cavernoso do Sistema Nervoso Central , Hemangioma Cavernoso , Idoso , Neoplasias do Tronco Encefálico/diagnóstico por imagem , Neoplasias do Tronco Encefálico/cirurgia , Hemangioma Cavernoso/diagnóstico por imagem , Hemangioma Cavernoso/cirurgia , Hemangioma Cavernoso do Sistema Nervoso Central/diagnóstico por imagem , Hemangioma Cavernoso do Sistema Nervoso Central/cirurgia , Humanos , Masculino , Procedimentos Neurocirúrgicos , Ponte/diagnóstico por imagem , Ponte/cirurgia
10.
Medicine (Baltimore) ; 100(21): e25696, 2021 May 28.
Artigo em Inglês | MEDLINE | ID: mdl-34032693

RESUMO

RATIONALE: Free-floating thrombi in the intracranial artery are rare. We report a case of a free-floating and spinning thrombus caused by turbulent flow distal to the basilar artery stenosis. We compare thrombus changes in a series of images according to time and describe the approach to treatment and thrombosis resolution.. PATIENT CONCERNS: A 55-year-old man presented to the emergency department on March 21, 2020, with left-sided weakness, bilateral limb ataxia, and a one-day history of dysarthria. Brain magnetic resonance imaging showed multifocal infarctions in the pons and cerebellum with severe basilar stenosis. DIAGNOSES: Digital subtraction angiography showed severe focal stenosis. A relatively large oval-shaped mobile thrombus was observed spinning due to turbulent flow at the distal portion of the stenosis. INTERVENTIONS: We administered a combination antithrombotic regimen of warfarin and clopidogrel for 50 days. OUTCOMES: No thrombus was observed on the third follow-up digital subtraction angiography. LESSONS: No previous study has directly observed a mobile thrombus in the intracranial artery using digital subtraction angiography. We used a combination antithrombotic strategy, which was effective after long-term, rather than short-term, use.


Assuntos
Artéria Basilar/patologia , Infarto Cerebral/diagnóstico , Fibrinolíticos/administração & dosagem , Trombose/diagnóstico , Insuficiência Vertebrobasilar/diagnóstico , Angiografia Digital , Artéria Basilar/diagnóstico por imagem , Cerebelo/irrigação sanguínea , Cerebelo/diagnóstico por imagem , Angiografia Cerebral , Infarto Cerebral/tratamento farmacológico , Infarto Cerebral/etiologia , Clopidogrel/administração & dosagem , Quimioterapia Combinada/métodos , Humanos , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Ponte/irrigação sanguínea , Ponte/diagnóstico por imagem , Trombose/complicações , Trombose/tratamento farmacológico , Resultado do Tratamento , Insuficiência Vertebrobasilar/tratamento farmacológico , Insuficiência Vertebrobasilar/etiologia , Insuficiência Vertebrobasilar/patologia , Varfarina/administração & dosagem
11.
J Med Case Rep ; 15(1): 246, 2021 May 18.
Artigo em Inglês | MEDLINE | ID: mdl-34001259

RESUMO

BACKGROUND: Chronic lymphocytic inflammation with pontine perivascular enhancement responsive to steroids is a clinically and radiographically distinct inflammatory syndrome affecting multiple structures of the brain, including the cerebellum, brainstem, and spinal cord. The clinical presentation can be variable, including ataxia, nystagmus, dysarthria, dysphagia, and other subacute brainstem, cranial nerve, or cerebellar symptoms. These symptoms can be subacute to chronic, episodic, and progressive, making the diagnosis challenging. The hallmark radiographic magnetic resonance imaging findings are gadolinium-enhancing punctate lesions predominantly "peppering" the pons in a perivascular pattern. CASE PRESENTATION: Here, we describe a case and literature review of a 74-year-old Caucasian male who presented with subacute symptoms of ataxia, diplopia, and generalized fatigue. Physical examination was notable for horizontal nystagmus and wide-based gait. Magnetic resonance imaging revealed angiocentric enhancement predominantly in the brainstem and cerebellum, with involvement of the basal ganglia, thalami, and supratentorial white matter. Meanwhile, a screening computed tomography scan demonstrated a right upper lobe mass with biopsy proving primary lung cancer. Biopsy of one of the brain lesions showed perivascular infiltrate primarily composed of CD3+ T cells, scattered CD20+ B cells, and no signs of malignancy. The patient was started on high-dose glucocorticoids followed by a maintenance regimen with rapid improvement clinically and radiographically. Given extensive work-up was negative, these clinical and radiographic findings were consistent with chronic lymphocytic inflammation with pontine perivascular enhancement responsive to steroids. CONCLUSIONS: This case illustrates the difficulty of diagnosing chronic lymphocytic inflammation with pontine perivascular enhancement responsive to steroids, given its variable presentation, lack of specific laboratory findings, and poorly understood pathogenesis. We demonstrate a case that responded well to oral corticosteroid burst followed by a taper to the lowest corticosteroid dose clinically possible. Failure to recognize this syndrome could result in permanent central nervous system morbidity. Therefore, earlier recognition is crucial for this treatable condition.


Assuntos
Neoplasias , Ponte , Idoso , Glucocorticoides/uso terapêutico , Humanos , Inflamação/tratamento farmacológico , Imageamento por Ressonância Magnética , Masculino , Ponte/diagnóstico por imagem , Esteroides
12.
Neurol Sci ; 42(8): 3479-3483, 2021 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-33950364

RESUMO

OBJECTIVES: Central pontine myelinolysis (CPM) is a neurological disorder characterized by damage to the myelin and oligodendrocytes in the pons. This review focuses on the history of CPM and the discovery of its association with the treatment of hyponatremia. METHODS: The author reviewed original publications regarding CPM, hyponatremia, and the treatment of hyponatremia. The author interviewed Dr. Robert Laureno who was a pioneer in CPM research with his animal work in dogs. RESULTS: Animal models demonstrated the role of the rapid correction of hyponatremia as causative of pontine and extrapontine myelinolytic lesions. Nevertheless, the importance of the speed of correction was widely denied. There were years of debates and only slow changes in expert guidelines. CONCLUSION: CPM occurs as a consequence of a rapid rise in serum sodium in individuals with chronic hyponatremia. It is recommended to increase plasma sodium concentration by no more than 8 to 10 mmol/L per 24 h in chronic hyponatremia.


Assuntos
Hiponatremia , Mielinólise Central da Ponte , Médicos , Animais , Cães , Humanos , Hiponatremia/complicações , Hiponatremia/terapia , Imageamento por Ressonância Magnética , Mielinólise Central da Ponte/etiologia , Mielinólise Central da Ponte/terapia , Ponte
14.
Clin Nucl Med ; 46(10): e501-e502, 2021 Oct 01.
Artigo em Inglês | MEDLINE | ID: mdl-34034309

RESUMO

ABSTRACT: Central pontine myelinolysis (CPM) is demyelinating condition of pons caused by osmotic stress due to rapid correction of hyponatremia. We present a case where CPM was an incidental finding on FDG PET/CT scan. To the best of our knowledge, only 3 case reports have been published till date describing CPM on 18F-FDG PET/CT scans.


Assuntos
Hiponatremia , Mielinólise Central da Ponte , Fluordesoxiglucose F18 , Humanos , Mielinólise Central da Ponte/diagnóstico por imagem , Ponte/diagnóstico por imagem , Tomografia por Emissão de Pósitrons combinada à Tomografia Computadorizada
15.
J Neuroimaging ; 31(3): 471-474, 2021 05.
Artigo em Inglês | MEDLINE | ID: mdl-33793026

RESUMO

BACKGROUND AND PURPOSE: Internuclear ophthalmoplegia is a dysfunction of conjugate eye movements, caused by lesions affecting the medial longitudinal fasciculus (MLF). Multiple sclerosis (MS) and ischemic stroke represent the most common pathophysiologies. While magnetic resonance imaging (MRI) allows for localizing lesions affecting the MLF, comprehensive comparative studies exploring potential different spatial characteristics of lesions affecting the MLF are missing until now. METHODS: We retrospectively investigated MRI examinations of 82 patients (40 patients with MS and 42 patients with ischemic stroke). For lesion localization, the brainstem was segmented into (1) ponto-medullary junction, (2) mid pons, (3) upper pons, and (4) mesencephalon. RESULTS: Corresponding lesions affecting the MLF were observed in 29/40 (72.5%) MS and 38/42 (90.5%) stroke patients. Compared to stroke patients, MS patients had significantly more lesions in multiple locations (P < .001). Stroke patients showed more lesions at the level of the mesencephalon (P < .001), while lesions at the level of the ponto-medullary junction, mid, and upper pons did not statistically differ between the groups. CONCLUSION: Our results demonstrate that multiple lesions affecting the MLF make inflammatory-demyelination due to MS more likely, while lesion localization at the level of the mesencephalon favors ischemia.


Assuntos
Isquemia Encefálica/patologia , AVC Isquêmico/patologia , Esclerose Múltipla/patologia , Transtornos da Motilidade Ocular/diagnóstico por imagem , Transtornos da Motilidade Ocular/patologia , Adulto , Idoso , Isquemia Encefálica/diagnóstico por imagem , Tronco Encefálico/patologia , Feminino , Humanos , AVC Isquêmico/diagnóstico por imagem , Imageamento por Ressonância Magnética/métodos , Masculino , Mesencéfalo/patologia , Pessoa de Meia-Idade , Esclerose Múltipla/diagnóstico por imagem , Ponte/patologia , Estudos Retrospectivos
16.
Wiad Lek ; 74(1): 161-164, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33851608

RESUMO

A very rare inflammatory disease of CNS, CLIPPERS syndrome, was recently described and only a few sporadic cases are reported in the medical literature. Its etiology and pathogenesis are unknown, that together with the polymorphic and sometimes confounding neurological manifestations, and radiological findings represent a real diagnostic and therapeutic challenge for clinicians. Aim: To highlight the importance of clear and specific diagnostic assessment. Here we present the case of a 40-year-old male with a subacute lymphocytic midbrain inflammation accompanied by vasculitis. We discuss the symptoms, imaging and treatment of this lesion.


Assuntos
Imageamento por Ressonância Magnética , Ponte , Adulto , Tronco Encefálico , Humanos , Inflamação , Masculino , Síndrome
17.
Clin Neurophysiol ; 132(6): 1264-1273, 2021 06.
Artigo em Inglês | MEDLINE | ID: mdl-33867252

RESUMO

OBJECTIVE: The purpose of this study is to investigate changes in autonomic activities and systemic circulation generated by surgical manipulation or electrical stimulation to the human brain stem. METHODS: We constructed a system that simultaneously recorded microsurgical field videos and heart rate variability (HRV) that represent autonomic activities. In 20 brain stem surgeries recorded, HRV features and sites of surgical manipulation were analyzed in 19 hypertensive epochs, defined as the periods with transient increases in the blood pressure. We analyzed the period during electrical stimulation to the ponto-medullary junction, performed for the purpose of monitoring a cranial nerve function. RESULTS: In the hypertensive epoch, HRV analysis showed that sympathetic activity predominated over the parasympathetic activity. The hypertensive epoch was more associated with surgical manipulation of the area in the caudal pons or the rostral medulla oblongata compared to controls. During the period of electrical stimulation, there were significant increases in blood pressures and heart rates, accompanied by sympathetic overdrive. CONCLUSIONS: Our results provide physiological evidence that there is an important autonomic center located adjacent to the ponto-medullary junction. SIGNIFICANCE: A large study would reveal a candidate target of neuromodulation for disorders with autonomic imbalances such as drug-resistant hypertension.


Assuntos
Pressão Sanguínea/fisiologia , Estimulação Elétrica/efeitos adversos , Hipertensão/etiologia , Bulbo/fisiopatologia , Ponte/fisiopatologia , Sistema Nervoso Simpático/fisiopatologia , Taquicardia/etiologia , Adulto , Idoso , Encéfalo/fisiopatologia , Encéfalo/cirurgia , Neoplasias Encefálicas/fisiopatologia , Neoplasias Encefálicas/cirurgia , Feminino , Humanos , Hipertensão/fisiopatologia , Monitorização Neurofisiológica Intraoperatória , Masculino , Pessoa de Meia-Idade , Taquicardia/fisiopatologia
18.
Rinsho Shinkeigaku ; 61(5): 319-324, 2021 May 19.
Artigo em Japonês | MEDLINE | ID: mdl-33867416

RESUMO

A 61-year-old man was admitted to our hospital due to cerebral infarction in the pons and the right putamen. On admission (day 3 from symptom onset), laboratory testing showed a white blood cell count of 13,100/µl with hypereosinophilia of 3,734/µl. As deep vein thrombosis was detected on contrast-enhanced CT, we started anticoagulation therapy. There were no cardio-embolic sources, including right-to-left shunt, but eosinophil infiltration was found in biopsy specimens of the gastric mucosa. These findings allowed us to diagnose multiple perforator infarction due to idiopathic hypereosinophilic syndrome (idiopathic HES). After the administration of oral prednisolone was started on day 10, his hypereosinophilia rapidly improved, and no recurrence of deep perforator infarction occurred other than a symptomatic infarction in the left putamen at day 19. There are a few reports of idiopathic HES with multiple infarctions developing in deep perforator regions. The current case suggests that idiopathic HES could cause multiple cerebral infarction restricted to deep perforator areas.


Assuntos
Infarto Cerebral/etiologia , Síndrome Hipereosinofílica/complicações , Síndrome Hipereosinofílica/tratamento farmacológico , Administração Oral , Eosinófilos/patologia , Mucosa Gástrica/patologia , Humanos , Síndrome Hipereosinofílica/patologia , Masculino , Pessoa de Meia-Idade , Ponte/irrigação sanguínea , Prednisolona/administração & dosagem , Pulsoterapia , Putamen/irrigação sanguínea , Resultado do Tratamento , Trombose Venosa/etiologia
19.
J Neurosci ; 41(22): 4795-4808, 2021 06 02.
Artigo em Inglês | MEDLINE | ID: mdl-33906900

RESUMO

Coordination of skilled movements and motor planning relies on the formation of regionally restricted brain circuits that connect cortex with subcortical areas during embryonic development. Layer 5 neurons that are distributed across most cortical areas innervate the pontine nuclei (basilar pons) by protrusion and extension of collateral branches interstitially along their corticospinal extending axons. Pons-derived chemotropic cues are known to attract extending axons, but molecules that regulate collateral extension to create regionally segregated targeting patterns have not been identified. Here, we discovered that EphA7 and EfnA5 are expressed in the cortex and the basilar pons in a region-specific and mutually exclusive manner, and that their repulsive activities are essential for segregating collateral extensions from corticospinal axonal tracts in mice. Specifically, EphA7 and EfnA5 forward and reverse inhibitory signals direct collateral extension such that EphA7-positive frontal and occipital cortical areas extend their axon collaterals into the EfnA5-negative rostral part of the basilar pons, whereas EfnA5-positive parietal cortical areas extend their collaterals into the EphA7-negative caudal part of the basilar pons. Together, our results provide a molecular basis that explains how the corticopontine projection connects multimodal cortical outputs to their subcortical targets.SIGNIFICANCE STATEMENT Our findings put forward a model in which region-to-region connections between cortex and subcortical areas are shaped by mutually exclusive molecules to ensure the fidelity of regionally restricted circuitry. This model is distinct from earlier work showing that neuronal circuits within individual cortical modalities form in a topographical manner controlled by a gradient of axon guidance molecules. The principle that a shared molecular program of mutually repulsive signaling instructs regional organization-both within each brain region and between connected brain regions-may well be applicable to other contexts in which information is sorted by converging and diverging neuronal circuits.


Assuntos
Orientação de Axônios/fisiologia , Efrina-A5/metabolismo , Neocórtex/embriologia , Vias Neurais/embriologia , Ponte/embriologia , Receptor EphA7/metabolismo , Animais , Feminino , Masculino , Camundongos , Camundongos Endogâmicos C57BL , Neocórtex/metabolismo , Vias Neurais/metabolismo , Ponte/patologia
20.
Spine Deform ; 9(5): 1411-1418, 2021 09.
Artigo em Inglês | MEDLINE | ID: mdl-33861426

RESUMO

PURPOSE: The routine use of Ponte osteotomies in adolescent idiopathic scoliosis (AIS) surgery is controversial with conflicting data for coronal plane correction and little analysis in the sagittal plane. The objective of this study was to analyze the efficacy of Ponte osteotomies in large curve AIS. METHODS: A single institution, prospectively-collected series of consecutive AIS patients who had Ponte osteotomies (P cohort) was directly matched to patients with no Pontes (NP cohort) by age, gender, Lenke classification, surgeon, coronal, and sagittal Cobb angles. The radiographic review included adjusted values using a 3D-derived published formula for preoperative T5-T12 kyphosis. Patient-reported outcomes (PROs) were assessed with the SRS-30 and Spinal Appearance Questionnaire (SAQ). RESULTS: There were 68 patients (34/cohort) with minimum 2-year follow-up with no differences between P and NP cohorts in age, preoperative coronal Cobb (74.5° vs 70.8°), flexibility index, measured or 3D-adjusted T5-T12 kyphosis. Rod material/diameter, fusion levels, blood loss, and operative time did not differ, but implant density was higher in the P group (1.53 vs 1.31, p < 0.001). The P group had 7.9% greater coronal Cobb correction (66.6% vs 58.7%, p < 0.003) without difference in final Cobb angles (24.7° vs. 29.1°, p = 0.052). There were no differences in measured or adjusted T5-T12 kyphosis in the sagittal plane. The P group had a 15% rate of critical intraoperative neuromonitoring changes versus 0% in the NP group (p = 0.053). At follow-up, there were no differences in scoliometer measurements or any domain of SRS-30 or SAQ scores. CONCLUSION: In this first reported matched series of AIS patients, Ponte osteotomies provide small radiographic gains in the coronal plane with no improvement in the sagittal plane and no change in truncal rotation. There was a higher risk of critical intraoperative neuromonitoring changes, and no benefits in patient-reported outcomes. This calls into question the routine use of Ponte osteotomies in AIS, even for curves averaging 70 degrees. LEVEL OF EVIDENCE: II.


Assuntos
Cifose , Escoliose , Fusão Vertebral , Adolescente , Humanos , Cifose/diagnóstico por imagem , Cifose/cirurgia , Osteotomia , Ponte , Radiografia , Estudos Retrospectivos , Escoliose/diagnóstico por imagem , Escoliose/cirurgia , Vértebras Torácicas/diagnóstico por imagem , Vértebras Torácicas/cirurgia , Resultado do Tratamento
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