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Journal of the Intensive Care Society Feb 2016Systolic impairment is well reported in critically ill patients but diastolic function has been relatively understudied. The objective of this review was to assess... (Review)
Review
PURPOSE
Systolic impairment is well reported in critically ill patients but diastolic function has been relatively understudied. The objective of this review was to assess tissue Doppler indices of diastolic function in critically ill patients along with any association with mortality.
METHODS
A systematic review of articles in English using Medline, EMBASE, CINAHL and the Cochrane database of systematic reviews. Search terms included diastolic function, diastolic dysfunction, diastolic abnormal*, diastolic heart failure, diastolic filling, ventricular relaxation, pulmonary artery occlusion pressure, left ventricular filling pressure, cardiac dysfunction, intensive care, critical care, critically ill, critical illness, sepsis and septic shock. Only studies of critically ill adult patients (excluding post-cardiac surgical patients) whose diastolic function was assessed using tissue Doppler imaging were included. Study quality was assessed using a modified version of the Newcastle-Ottawa Scale (NOS).
RESULTS
Nineteen studies were included, with a total of 1365 patients. All trials were observational. There was a large heterogeneity in patient populations and the methodology of tissue Doppler assessment of diastology resulting in a descriptive analysis. Patient groups included severe sepsis or septic shock (5 studies), septic shock (5 studies), systemic inflammatory response syndrome and shock (1 study), septic shock and acute lung injury (1 study), cancer and septic shock (2 studies), general ICU patients (1 study), combined medical and surgical ICU (2 studies) and sub-arachnoid haemorrhage patients (2 studies). Seventeen studies scored 5/6 on the NOS with the remaining two scoring 4/6. Fourteen studies reported on numbers of patients diagnosed with diastolic dysfunction (500/999, mean 50%, range 20-92%). Three studies found that diastolic dysfunction was an independent predictor of mortality.
CONCLUSIONS
Current data shows a large range in the incidence of diastolic dysfunction in this patient population and a variable link with mortality. Future research should focus on the definition of normal values for diastolic function in critically ill patients along with the effects of ICU therapies and consensus criteria for its assessment in this patient population.
PubMed: 28979458
DOI: 10.1177/1751143715595641 -
Advanced Drug Delivery Reviews 2020Administration of substances directly into the cerebrospinal fluid (CSF) that surrounds the brain and spinal cord is one approach that can circumvent the blood-brain...
Administration of substances directly into the cerebrospinal fluid (CSF) that surrounds the brain and spinal cord is one approach that can circumvent the blood-brain barrier to enable drug delivery to the central nervous system (CNS). However, molecules that have been administered by intrathecal injection, which includes intraventricular, intracisternal, or lumbar locations, encounter new barriers within the subarachnoid space. These barriers include relatively high rates of turnover as CSF clears and potentially inadequate delivery to tissue or cellular targets. Nanomedicine could offer a solution. In contrast to the fate of freely administered drugs, nanomedicine systems can navigate the subarachnoid space to sustain delivery of therapeutic molecules, genes, and imaging agents within the CNS. Some evidence suggests that certain nanomedicine agents can reach the parenchyma following intrathecal administration. Here, we will address the preclinical and clinical use of intrathecal nanomedicine, including nanoparticles, microparticles, dendrimers, micelles, liposomes, polyplexes, and other colloidalal materials that function to alter the distribution of molecules in tissue. Our review forms a foundational understanding of drug delivery to the CSF that can be built upon to better engineer nanomedicine for intrathecal treatment of disease.
Topics: Animals; Biological Transport; Blood-Brain Barrier; Cerebral Ventricles; Cerebrospinal Fluid; Drug Delivery Systems; Humans; Injections, Spinal; Liposomes; Micelles; Nanoparticles; Subarachnoid Space
PubMed: 32142739
DOI: 10.1016/j.addr.2020.02.006 -
Clinical Neurology and Neurosurgery Nov 2022Spontaneous resolution of syringomyelia has rarely been reported in the literature. Rarer still are cases wherein this process is associated with pregnancy and... (Review)
Review
BACKGROUND
Spontaneous resolution of syringomyelia has rarely been reported in the literature. Rarer still are cases wherein this process is associated with pregnancy and parturition. We review theories on syringomyelia development and spontaneous resolution to better understand the role pregnancy and parturition may play in both processes.
METHODS
We present a 30-year-old female with MRI-confirmed spontaneous syrinx regression following caesarean delivery of a full-term pregnancy. We additionally review the literature to identify previously reported cases of spontaneous syrinx regression both independent of and associated with pregnancy.
RESULTS
Including the present case, 39 cases describing spontaneous regression of syringomyelia have been reported in the literature, of which only four are associated with pregnancy and parturition. 75% of all reported cases were associated with type I Chiari malformation, though several disorders of the craniocervical junction and spinal canal were implicated. Complete syrinx regression was achieved in 33.3% of cases and 5% of cases described recurrence of syringomyelia following the spontaneous resolution.
CONCLUSION
Syringomyelia likely develops due to disturbance of the physiologic flow of cerebrospinal fluid around the craniocervical junction and the obex. Several mechanisms including fissuring of the spinal cord parenchyma and reduction of subarachnoid scarring are likely involved in this process. In the setting of pregnancy, additional mechanisms surrounding the increased intraabdominal forces imparted by a growing fetus, Valsalva-like strain experienced during labor, and hemodynamic changes that occur to accommodate gestation are likely implicated. Nevertheless, patients should continue to be monitored periodically for syrinx recurrence.
Topics: Pregnancy; Female; Humans; Adult; Syringomyelia; Arnold-Chiari Malformation; Subarachnoid Space; Magnetic Resonance Imaging; Parturition
PubMed: 36049402
DOI: 10.1016/j.clineuro.2022.107413 -
Child's Nervous System : ChNS :... Apr 2020Primary cysts are believed to arise from the splitting of the arachnoid membrane during prenatal development and can be diagnosed in utero. Prenatal diagnosis is...
INTRODUCTION
Primary cysts are believed to arise from the splitting of the arachnoid membrane during prenatal development and can be diagnosed in utero. Prenatal diagnosis is uncommon; therefore, the evidence base for counselling expectant mothers is limited. The purpose of this article is to present a case series and review the current literature on prenatally diagnosed arachnoid cysts.
METHOD
A keyword search of hospital electronic records was performed for all patients with a prenatally diagnosed arachnoid cyst at a tertiary neurosurgical centre. Case notes were reviewed for all patients diagnosed between 2005 and 2017. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were used to structure a systematic review of all English language articles published up to May 2018.
RESULTS
A total of eight eligible patients were identified from our own records and 123 from the literature. Sixty-eight per cent of patients had a normal outcome. Sixty-three per cent of patients underwent surgical intervention which was not associated with abnormal outcome. The diagnosis of syndromic/genetic diagnosis (p < 0.001) and the presence of other intra-cranial anatomical abnormalities (p = 0.05) were significant predictors of abnormal outcome.
CONCLUSION
The pathogenesis and prognosis of a prenatal arachnoid cyst diagnosis remain unclear. These results suggest favourable outcomes from simple cysts without associated abnormalities and expectant mothers should be counselled accordingly. A wider prospective review is required to better established evidence-based practice.
Topics: Arachnoid Cysts; Female; Humans; Pregnancy; Prenatal Diagnosis; Prognosis; Prospective Studies
PubMed: 31897633
DOI: 10.1007/s00381-019-04477-6 -
World Neurosurgery Dec 2021Fenestrations of cerebral arteries are congenital variants that develop when primitive vessels fuse incompletely. An association between the incidence of aneurysm and a...
BACKGROUND
Fenestrations of cerebral arteries are congenital variants that develop when primitive vessels fuse incompletely. An association between the incidence of aneurysm and a fenestrated artery has been noted in the radiological literature. However, technical limitations of radiological studies may hamper visualization of small fenestrations and aneurysms. We sought to analyze a large, postmortem collection of human brains to assess the association between aneurysm formation and the presence of fenestrations.
METHODS
This study included 333 formalin-fixed brains. The arachnoid was dissected under a microscope, the cerebral arteries were completely exposed, and fenestrations and aneurysms were identified and measured. For each specimen, age, sex, and all vascular abnormalities and variations were recorded for analysis.
RESULTS
Fenestrations were present in 41% of the specimens, and 37% of these were multiple. Fenestrations were 3.1 ± 2.5 mm long and most commonly occurred in the anterior communicating artery (63%). Aneurysms were present in 8% of the specimens, usually in the anterior communicating artery or the middle cerebral artery. An aneurysm correlated with a fenestration was detected in 2% of all specimens (n = 4) and was not statistically significant (P = 0.18).
CONCLUSIONS
Fenestrations of the intracranial arteries are a common anatomical finding. They are present most often in the anterior communicating artery. Most aneurysms were detected in the anterior communicating artery and middle cerebral artery. We conclude that the existence of an aneurysm in a fenestrated artery is an incidental, rather than causal, relationship.
Topics: Adult; Cadaver; Cerebral Arteries; Female; Humans; Intracranial Aneurysm; Male; Middle Aged
PubMed: 34506985
DOI: 10.1016/j.wneu.2021.08.137 -
Acta Neurologica Belgica Dec 2023To report our experience on giant tumefactive Virchow-Robin spaces (GTVRS) in the frontal lobe and perform a systematic review of previous reports on GTVRS.
AIM
To report our experience on giant tumefactive Virchow-Robin spaces (GTVRS) in the frontal lobe and perform a systematic review of previous reports on GTVRS.
MATERIALS AND METHODS
This is a retrospective single-center study reporting the clinical manifestations, magnetic resonance (MR) imaging appearance, differential diagnosis, and management of two patients diagnosed with frontal lobe GTVRS at Bahcesehir University School of Medicine Goztepe Hospital in the past 5 years. A systematic literature search was performed in the PubMed and Google Scholar databases, with case selection criteria including Virchow-Robin spaces (VRS) size greater than 1.5 cm, frontal lobe localization, and the presence of MR imaging. The search strategy included only English language keywords. The systematic review was searched between database inception and May 6, 2022.
RESULTS
A total of 18 cases were included in the study. Of the 15 cases with known sex, nine were female and six male. The median age was 29.8 with an age range of 4-57. Eleven of the 18 lesions were in the right frontal lobe. The lesions were multilocular in 15 cases and unilocular in three cases. All lesions had signal intensity as cerebrospinal fluid, showed no perifocal edema, and did not enhance. A hyperintensity was noted around the 14 lesions on the FLAIR sequence. Ten lesions showed cortical thinning adjacent to the lesion. No abnormality was detected on DWI, SWI, and MRS. Follow-up imaging was available in ten patients without any interval change. Unnecessary surgical interventions were noted in three cases.
CONCLUSIONS
The results of reported cases and the literature review emphasize the role of MR imaging in the diagnosis of frontal lobe GTVRS. Beyond diagnostic consideration, GTVRS may have prognostic value and often indicate a "don't touch lesion" albeit requiring further consideration on a case-to-case basis. Familiarity with this entity improves diagnostic accuracy and, prevents accidental diagnosis of any neoplasm or other diseases.
Topics: Humans; Male; Female; Adult; Glymphatic System; Retrospective Studies; Subarachnoid Space; Frontal Lobe; Magnetic Resonance Imaging
PubMed: 36273113
DOI: 10.1007/s13760-022-02098-6 -
Acta Neurochirurgica Jul 2018Glioependymal cysts (GECs) are benign intracranial cysts that have been rarely reported in the literature. The exact pathogenesis of these developmental anomalies is...
BACKGROUND
Glioependymal cysts (GECs) are benign intracranial cysts that have been rarely reported in the literature. The exact pathogenesis of these developmental anomalies is controversial. Moreover, the terminology used to name GECs and other intracranial cysts is confusing because they are undistinguishably reported under a variety of names. The available information in the literature about GECs is scarce, and for this reason, a detailed description about these uncommon lesions is necessary.
METHODS
An illustrative case is presented; in addition, a PubMed and Scopus search adhering to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines was performed to include studies reporting patients with GECs. Different information was analyzed in these patients to describe the characteristics of this condition. In addition, different sources of literature were analyzed to complete the description of this clinical entity.
RESULTS
The literature review yielded 26 cases of patients with intracranial GECs showing a diversity of clinical manifestations. All studies were case reports or small case series. Different characteristics of GECs are described. Moreover, the authors suggest an updated classification of intracranial benign cysts.
CONCLUSIONS
The data collected from this review shows that GECs are rare and very often are erroneously named. They are congenital benign lesions with a neuroectodermal origin that share many radiological characteristics with a variety of intracranial benign cysts. The definite diagnosis of GECs is confirmed by the presence of a glial layer in the cyst wall at histological examination. The appropriate surgical technique should be selected according to the location of the cyst and its proximity to the ventricles or subarachnoid space.
Topics: Aged; Brain Diseases; Cerebral Ventricles; Cysts; Female; Humans; Neuroglia; Subarachnoid Space
PubMed: 29802560
DOI: 10.1007/s00701-018-3566-0 -
World Neurosurgery Jan 2018Arachnoid cyst (AC)-associated chronic subdural hematoma (CSDH) differs significantly from its counterparts without AC in epidemiologic, demographic, and clinical... (Review)
Review
BACKGROUND
Arachnoid cyst (AC)-associated chronic subdural hematoma (CSDH) differs significantly from its counterparts without AC in epidemiologic, demographic, and clinical characteristics, as well as in management and prognosis. This study was conducted to further examine the epidemiologic, demographic, and clinical characteristics; diagnosis; treatment; and prognosis of AC-associated CSDH.
METHODS
This was a retrospective study of the medical records at the neurosurgical departments of 2 institutions along with a systematic PubMed search for relevant studies published in English or Chinese.
RESULTS
A total of 182 patients (148 males; 81.3%) were evaluated, including 14 cases in our present series. The patients ranged in age from 1 to 80 years (mean age, 24.41 ± 13.69 years). Among the 175 patients with adequate prehospital history information, 119 (68%) had a history of recent head trauma or sport-related injury. AC locations included the middle fossa and sylvian fissure in 162 cases (89.0%), cerebral convexity in 17 cases (9.3%), posterior fossa in 2 cases (1.1%), and interhemispheric fissure in 1 case (0.5%). Among the 161 patients with specific data on outcomes, 159 (98.8%) had favorable recovery, 1 patient had an evident neurologic deficit, and 1 patient died from cardiac arrest.
CONCLUSIONS
CSDH is a rare complication in patients with intracranial AC. Male children, juveniles, and young adults with recent head trauma or sport-related injury are most commonly inflicted. Burr hole drainage is the first-choice surgical procedure in symptomatic patients and is still effective in some recurrent cases. Fenestration or resection of the AC membrane is not a requisite in patients with previous asymptomatic AC.
Topics: Adolescent; Adult; Aged; Aged, 80 and over; Arachnoid Cysts; Child; Child, Preschool; Female; Hematoma, Subdural, Chronic; Humans; Infant; Male; Middle Aged; Retrospective Studies; Young Adult
PubMed: 28962953
DOI: 10.1016/j.wneu.2017.09.115 -
Neurosurgical Focus Apr 2016OBJECTIVE Arachnoid cysts (ACs) are congenital lesions bordered by an arachnoid membrane. Researchers have postulated that individuals with an AC demonstrate a higher...
OBJECTIVE Arachnoid cysts (ACs) are congenital lesions bordered by an arachnoid membrane. Researchers have postulated that individuals with an AC demonstrate a higher rate of structural brain injury after trauma. Given the potential neurological consequences of a structural brain injury requiring neurosurgical intervention, the authors sought to perform a systematic review of sport-related structural-brain injury associated with ACs with a corresponding quantitative analysis. METHODS Titles and abstracts were searched systematically across the following databases: PubMed, Embase, CINAHL, and PsycINFO. The review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. Peer-reviewed case reports, case series, or observational studies that reported a structural brain injury due to a sport or recreational activity (hereafter referred to as sport-related) with an associated AC were included. Patients were excluded if they did not have an AC, suffered a concussion without structural brain injury, or sustained the injury during a non-sport-related activity (e.g., fall, motor vehicle collision). Descriptive statistical analysis and time to presentation data were summarized. Univariate logistic regression models to assess predictors of neurological deficit, open craniotomy, and cystoperitoneal shunt were completed. RESULTS After an initial search of 994 original articles, 52 studies were found that reported 65 cases of sport-related structural brain injury associated with an AC. The median age at presentation was 16 years (range 4-75 years). Headache was the most common presenting symptom (98%), followed by nausea and vomiting in 49%. Thirteen patients (21%) presented with a neurological deficit, most commonly hemiparesis. Open craniotomy was the most common form of treatment (49%). Bur holes and cyst fenestration were performed in 29 (45%) and 31 (48%) patients, respectively. Seven patients (11%) received a cystoperitoneal shunt. Four cases reported medical management only without any surgical intervention. No significant predictors were found for neurological deficit or open craniotomy. In the univariate model predicting the need for a cystoperitoneal shunt, the odds of receiving a shunt decreased as age increased (p = 0.004, OR 0.62 [95% CI 0.45-0.86]) and with male sex (p = 0.036, OR 0.15 [95% CI 0.03-0.88]). CONCLUSIONS This systematic review yielded 65 cases of sport-related structural brain injury associated with ACs. The majority of patients presented with chronic symptoms, and recovery was reported generally to be good. Although the review is subject to publication bias, the authors do not find at present that there is contraindication for patients with an AC to participate in sports, although parents and children should be counseled appropriately. Further studies are necessary to better evaluate AC characteristics that could pose a higher risk of adverse events after trauma.
Topics: Adolescent; Adult; Aged; Arachnoid Cysts; Brain Concussion; Brain Injuries; Child; Child, Preschool; Female; Headache; Humans; Magnetic Resonance Imaging; Male; Middle Aged; Neurosurgical Procedures; Retrospective Studies; Sports; Young Adult
PubMed: 27032926
DOI: 10.3171/2016.1.FOCUS15608 -
World Neurosurgery Jan 2018Arachnoid cysts and intracranial aneurysms are not rare, but it is unusual for an aneurysm to be associated with an arachnoid cyst. The objective of this study was to... (Review)
Review
BACKGROUND
Arachnoid cysts and intracranial aneurysms are not rare, but it is unusual for an aneurysm to be associated with an arachnoid cyst. The objective of this study was to reveal the association between arachnoid cysts and intracranial aneurysms.
METHODS
Methods included to report 3 cases with these 2 pathologies and to perform a systematic review of the English and Japanese literature using PubMed, Scopus, and Ichushi Web.
RESULTS
The first case was of a 46-year-old man with a subarachnoid hemorrhage on the basal cistern and bilateral arachnoid cysts in the middle fossa, the second was that of a 29-year-old woman with a subarachnoid hemorrhage at the basal cistern and an arachnoid cyst in the left middle fossa, and the third was that of a 60-year-old man with a right putaminal hemorrhage and contralateral unruptured aneurysm and arachnoid cyst. A literature search for similar cases found 27 patients.
CONCLUSIONS
It was difficult to diagnose a ruptured aneurysm in some cases with an arachnoid cyst because computed tomography scan showed atypical findings, such as no hemorrhage, intracystic localized hemorrhage, or subdural hematoma. This review revealed that aneurysms and arachnoid cysts were significantly located ipsilaterally and that they occurred together in relatively young patients.
Topics: Adult; Aneurysm, Ruptured; Arachnoid Cysts; Cerebral Angiography; Craniotomy; Female; Humans; Intracranial Aneurysm; Male; Middle Aged; Subarachnoid Hemorrhage; Tomography, X-Ray Computed
PubMed: 28964944
DOI: 10.1016/j.wneu.2017.09.139