Prediction of Postoperative Risk of Raised Intracranial Pressure After Spontaneous Skull Base Cerebrospinal Fluid Leak Repair.

BACKGROUND: A relationship between idiopathic intracranial hypertension and spontaneous skull base cerebrospinal fluid (CSF) leaks has been proposed, by which CSF leak decreases intracranial pressure (ICP) and masks the symptoms and signs of elevated ICP. These patients are at risk of developing papilledema, symptoms of elevated ICP, or a recurrent CSF leak after CSF leak repair. The objective of this study was to assess whether radiographic signs of raised ICP on preoperative magnetic resonance or computed venography (MRI or CTV) are predictors of postoperative papilledema, recurrence of CSF leak, or need for CSF shunt surgery. METHODS: We performed a retrospective review of systematically collected demographics, fundus examination, and presurgical brain MRI and magnetic resonance venography/computed tomography venography (MRV/CTV) in patients seen at 1 institution between 2013 and 2019 with spontaneous skull base CSF leak repair. Patients were divided into 2 groups depending on whether they developed papilledema, recurrent CSF leak, or required CSF shunting (Group 1) or not (Group 2). RESULTS: Fifty-seven patients were included, among whom 19 were in Group 1. There was no difference in demographic characteristics or clinical features between patients in Group 1 and Group 2. Controlling for other imaging features, bilateral transverse venous sinus stenosis (TVSS) on preoperative imaging increased the odds of being in Group 1 by 4.2 times (95% confidence interval [CI], 1.04-21.2, P = 0.04), optic nerve tortuosity decreased the odds of being in Group 1 by 8.3 times (95% CI: 1.4-74.6, P = 0.02). CONCLUSION: Imaging of the intracranial venous system with MRV or CTV is warranted before repair of spontaneous CSF leak, as bilateral TVSS is an independent risk factor for postoperative papilledema, CSF leak recurrence, or need for a CSF shunting procedure.

Progressive Central Artery Occlusion, Ophthalmic Artery Occlusion, and Hemispheric Intracranial Thrombosis after COVID-19 mRNA Vaccine Application: Case Report.

Thromboembolic events as a result of COVID-19 mRNA vaccination are a rare, though life-threatening complication. In this case report, we describe a 40-year-old female patient who developed central retinal artery and ophthalmic artery occlusion progressing to intracranial thrombosis 3 weeks after vaccination with the Pfizer-BioNTech COVID-19 vaccine. Initially, she presented with progressive acute and painless unilateral vision loss in her left eye. Dilated fundoscopy of left eye showed macular whitening with sparing of the area of cilioretinal artery distribution. Labs revealed a normal erythrocyte sedimentation rate, C-reactive protein, and platelet count. Computerized tomography angiography of the head and neck showed an occlusion of the entire left cervical internal carotid artery and occlusion of the origin of the left external carotid artery. Despite treatment with heparin, her vision declined to no light perception. Ten days later, the patient presented with right peripheral vision loss and was found to have a new left posterior cerebral artery/posterior inferior cerebellar artery stroke. Seventeen days later, she presented to the hospital with nausea and vertigo and was found to have a subacute infarction in the left parietal lobe corresponding to left anterior communicating artery/middle cerebral artery watershed territory. Hypercoagulable disorders, vasculitis, cardiac arrhythmias, and intraventricular thrombi were excluded. Fundus fluorescein angiography confirmed central retinal artery occlusion and ophthalmic artery occlusion with impressive retina and choroid changes in fluorescein angiography patterns. This complication of mRNA COVID-19 vaccination has not been previously described in the literature and should be considered even weeks after initial presentation.

Increased rat neonatal activity influences adult cytokine levels and relative muscle mass.

Little is known about the effect of physical activity in early life on subsequent growth and regulation of inflammation. We previously reported that exposure of muscles in growing rats to IL-6 results in decreased muscle growth apparently because of a state of resistance to growth factors such IGF-I and that running exercise could ameliorate this growth defect. Herein, we hypothesized that increased activity, for a brief period during neonatal life, would pattern the adult rat toward a less inflammatory phenotype. Neonatal rats were induced to move about their cage for brief periods from d 5 to d 15 postpartum. Additional groups were undisturbed controls (CONs) and handled (HAND). Subgroups of rats were sampled at the age of 30 and 65 d. Relative to CON and HAND groups, the neonatal exercise (EX) group demonstrated a decrease in circulating levels of TNFα, IL-6, and IL-1ß in adulthood, primarily in male rats. In addition, adult male EX rats had lower body mass and increased skeletal muscle mass suggesting a leaner phenotype. The results of this study suggest that moderate increases in activity early in life can influence the adult toward a more healthy phenotype with regard to inflammatory mediators and relative muscle mass.