Brain disorders (Amsterdam, Netherlands)最新文献

Objective

Blake's pouch cyst is a cause of congenital non-communicating hydrocephalus. Recent study revealed that adult onset communicating normal pressure hydrocephalus sometimes accompanied by Blake's pouch cyst-like imaging abnormalities. However, relationships between two disease entities remains uncovered. The aim of this study was to investigate the prevalence of Blake's pouch cyst-like imaging abnormalities in idiopathic normal pressure hydrocephalus and their impact on the clinical features.

Methods

First, we investigated the existence of Blake's pouch cyst-like imaging abnormalities in 46 idiopathic normal pressure hydrocephalus patients (mean age 76.8 ± 5.2 years old; 28 women) and 247 normal controls (mean age 65.2 ± 4.0 years old; 120 women). Second, the demographic, clinical and imaging characteristics were compared between idiopathic normal pressure hydrocephalus with and without Blake's pouch cyst-like imaging abnormalities.

Results

Blake's pouch cyst-like imaging abnormalities were more prevalent in idiopathic normal pressure hydrocephalus patients (17.4 %) than in the normal population (2.4 %). Idiopathic normal pressure hydrocephalus with Blake's pouch cyst-like imaging abnormalities showed a trend toward a younger onset than those without Blake's pouch cyst-like imaging abnormalities, while clinical features, including the response to cerebrospinal fluid tap test and shunt treatment, did not differ between two groups.

Conclusions

Incomplete cerebrospinal fluid obstruction associated with Blake's pouch cyst-like imaging abnormalities may be a cause of idiopathic normal pressure hydrocephalus.

Thymic squamous cell carcinoma (TSCC) is a rare cancer that is typically characterized by low rates of brain metastases. However, when it does occur, brain metastases of TSCC can have significant clinical implications due to its rarity and lack of established management guidelines. In this literature review and case report, we explore the clinical presentation, management, and outcomes of patients with brain metastases of TSCC.

Our literature review found that brain metastases of TSCC are relatively rare, with an estimated incidence of 5-10 % among patients with advanced-stage disease. Management of brain metastases of TSCC often involves a combination of surgical resection, radiation therapy, and chemotherapy. However, due to the rarity of this condition, there is currently limited evidence to guide optimal treatment strategies.

We also present a case report of a patient with TSCC who was presented with a brain metastasis. This case highlights the importance of early diagnosis and prompt management of brain metastasis of TSCC to improve patient outcomes. Our review and case report underscore the need for further research to improve our understanding of the clinical characteristics, optimal management, and prognosis of patients with brain metastasis of TSCC.

Thalamic strokes may present with a wide variety of symptoms depending on their location, volume and lateralization. Hypersomnia is a less frequent manifestation, that has been associated with unilateral paramedian thalamic ischemic lesions. We report a case of a patient who presented to the emergency department (ED) with sudden onset of hypersomnolence. Initial head computed tomography (CT) showed no signs of acute ischemia. Follow-up head CT 24 h after thrombolysis exposed a hypodense lesion on the left ventromedial thalamic and mesencephalic regions, with corresponding T2/FLAIR hyperintensity and diffusion restriction on brain magnetic resonance imaging, confirming a recent ischemic stroke. Clinicians should be aware of the association between acute hypersomnia and strategic unilateral thalamic infarcts, particularly when the initial CT scan has no signs of acute ischemia.

Nanogels are emerging as promising nanocarriers for delivering therapeutic agents to treat central nervous system (CNS) disorders. Traditional therapeutic approaches for CNS disorders are often hindered by the inability to cross the blood-cerebrospinal fluid barrier (BCSFB) and blood-spinal cord barrier (BSCB), necessitating high and frequent dosages that can lead to off-target effects. Nanogels, however, offer a unique solution by enabling targeted delivery across these barriers with minimal dosages and a controlled-release mechanism, marking a significant advancement in CNS treatment. This narrative review explores the current knowledge and recent advancements in the application of nanogels for CNS disorders. Specifically, it highlights how chitosan-based, polyethylene glycol-based, polypeptide-based, and dextran-based nanogels effectively cross the BCSFB, while macrophage membrane-encapsulated and polyethylene glycol-based nanogels traverse the BSCB. These nanogels are compatible with a range of therapeutic agents, including neural stem cells, metformin, methotrexate, rolipram, oncomodulin, and antagomir-21, targeting CNS disorders like spinal cord injury and intervertebral disc degeneration. Additionally, nanogels can be administered through various routes such as intravenous, intranasal, intrathecal, and intraganglionic methods. Despite these promising developments, further research is necessary to fully elucidate their mechanisms of action and optimize their therapeutic efficacy for clinical applications.

Background

The pandemic's preventive measures adversely impacted physical and psychological well-being, leading to increased sleep issues and mental health problems. This study examines sleep health and mental well-being among individuals with multiple sclerosis (MS) during this period. It explores potential correlations between sleep problems and mental health in this population.

Methods

A cross-sectional design utilized an anonymous SurveyMonkey survey distributed to three MS centers, collecting responses from 24 individuals with MS (21 females, 3 males). Sleep data were assessed using the Functional Outcome of Sleep Questionnaire (FSOQ)-10, and mental health status was assessed using the Depression Anxiety Stress Scale (DASS)-21. FOSQ scores ≥17.9 indicated normal sleep, while the DASS-21 comprised stress, anxiety, and depression subscales, each with 7 questions rated on a 0–3 scale, with higher scores indicating greater mental health issues.

Results

Of 24 participants, 18 MS individuals reported functional sleep issues during the pandemic. Analysis revealed significantly lower productivity, vigilance, and social outcomes in the sleep problems group (p < .01). Additionally, this group had elevated stress (p = .004) and depression scores (p = .002). Negative correlations were observed between sleep scores and both stress (ρ = -0.485, p = .016) and depression (ρ = -0.562, p = .004).

Conclusions

75 % of MS individuals experienced functional sleep disturbances during the pandemic, with 25 % affected by stress, 16.6 % by anxiety, and 37 % by depression. Sleep issues are correlated with increased stress and depression levels. Recognizing the impact on rehabilitative outcomes, specialists must consider sleep behavior and mental health when designing therapies for individuals with MS.

Introduction

Treating dural arteriovenous fistulas (DAVFs) with endovascular embolization has proven to be effective. However, in cases where the DAVF is isolated or inaccessible via conventional endovascular methods, a combined surgical and endovascular approach may be necessary. This strategy provides a direct approach to the venous system and bypasses the site of sinus occlusion.

Methods

In this report, we present a case of direct Onyx embolization after navigated cannulation of the transverse sinus (TS) for the treatment of a left TS DAVF, along with a review of the literature on transcranial endovascular treatment of DAVF.

Results

The isolated TS was embolized with Onyx, filling both supratentorial and infratentorial draining cortical varices. The patient tolerated the procedure well, and follow-up angiography revealed no DAVF recurrence.

Discussion

Onyx has been used in very few case reports for transcranial DAVF embolization, even though its higher viscosity characteristics offer better control over distal migration at the possible cost of decreased penetration of the targeted lesion. When using coils, the sinus exposure must be long enough to allow for puncture at a certain distance from the DAVF. The superficial location of the isolated TS allowed us to use a syringe filled with Onyx to directly obliterate the sinus during a single burr-hole craniotomy.

Conclusions

This combined strategy might be a practical and efficient way to treat DAVFs with sinus occlusion. It can serve as the primary treatment option when addressing a DAVF involving a superficial sinus with drainage disconnected from both internal jugular veins.

Chatbots, also known as conversational agents, can guide customers in navigating websites, answer questions or act as personal assistants. They have recently entered the neuroscientific arena and can potentially revolutionise neurology and neuroscience. In this manuscript, we explore what chatbots can and cannot do in their interactions with students, patients and neurologists, and we analyse their potentialities and limitations.

Parkinson's disease is the second most frequent neurodegenerative disorder worldwide and is characterized by the presence of predominantly motor symptoms, the loss of dopaminergic neurons, and degeneration of the striatum. In addition to the motor symptoms of Parkinson´s disease, there are other non-motor symptoms such as hyposmia, sleep disorders, personality changes, pain, depression, gait, speech, and swallowing difficulties. Although there has been much research in the field, there is still no specific treatment for the disease. Current studies for new treatments use a variety of models, and the most used animals are rodents, primates, and non-mammals. This review aims to present the non-transgenic models for Parkinson's disease, providing an overview of each model, their advantages and disadvantages, and at last, how they could be helpful in the search for new treatments.

Background and objectives

While various pathologies affecting the foramen magnum region can have severe consequences, little research has been conducted on the unique morphological patterns in the West African subregion. The study aimed to assess these patterns and their implications for surgeries, comparing them with global standards.

Methods

A descriptive study was conducted on 315 patients over a two-year period, excluding those with specific abnormalities. Measurements obtained from cranial 1.5T MRI scans included anteroposterior and transverse diameters of the foramen magnum. From these, the foramen magnum area and index were calculated. The data was analyzed by inferential, comparative and descriptive statistics, and a p value < 0.05 was regarded as statistically significant.

Results

On average, the transverse and anteroposterior diameters were 28.51 mm and 33.02 mm for males and 28.39 mm and 33.47 mm for females, with a slightly smaller foramen magnum area in males (7.42 cm²) compared to females (7.47 cm²). Despite these differences, the variations were not statistically significant. However, the foramen magnum indices indicated medium size configuration for females and large size configuration for males, aligning with global trends.

Conclusion

The study concluded that West Africans exhibited lower foramen magnum area and indices compared to other regions, with minor differences between sexes. Females tended to have a medium size configuration, while males tended to have a larger size configuration. These findings provide valuable insights for clinicians, highlighting the importance of considering ethno-regional variations in surgical approaches and interventions related to the craniocervical junction.

Background

Endovascular treatment and thrombolytic therapy are widely used as the standard treatment for acute ischemic strokes. General Anesthesia (GA) is preferred over Conscious Sedation (CS) because it is associated with lower pain, anxiety, agitation and aspiration risk. However time is very fundemental in acute ischemic stroke treatment.

Methods

The search was done on the 30th of December 2022. The inclusion criteria of the studies were if they were randomized controlled clinical trials in design and compared between using conscious sedation and general anesthesia in endovascular treatment along with thrombolytic therapy.

Results

The total number of patients included in our analysis was 743 from six clinical trials. Our models showed a significant association between conscious sedation and improved disability (OR=1.32; 95%CI: 1.10–1.59). The model demonstrated that conscious sedation was significantly associated with lower mean stroke to procedure time (WMD=-11.93; 95%CI: -23.72- -0.14) and lower mean hospital arrival to procedure time (WMD=-8.30; 95%CI: -13.88- -2.72). Moreover, our analysis revealed that conscious sedation was significantly associated with lower hypotensive episodes (WMD=0.67; 95%CI: 0.48–0.95) and lower use of vasoactive drugs (WMD=0.75; 95%CI: 0.57–0.99). There were no significant differences between the two study groups in technical failures, successful recanalization or mortality.

Conclusion

CS demonstrated improved disability, shorter times to procedure, fewer hypotensive events, and lower use of vasoactive drugs. All of which reflect a better quality for CS over GA. Given together, these findings can help guide the clinical decision which should be tailored to the patients’ needs.