-
Fortschritte Der Neurologie-Psychiatrie May 2018A thorough neurological examination in emergency situations requires the evaluation of meningeal signs. Even though in most settings, evaluation of meningism is... (Review)
Review
A thorough neurological examination in emergency situations requires the evaluation of meningeal signs. Even though in most settings, evaluation of meningism is technically not very demanding, the interpretation of findings may prove difficult. As opposed to a widely held belief, clinical signs of meningism are neither specific nor highly sensitive for detection of meningitis or subarachnoid hemorrhage. A meaningful evaluation of meningeal signs, therefore, requires careful consideration of both clinical findings and other accessory symptoms.
Topics: Diagnosis, Differential; Emergency Medical Services; Humans; Meningism; Neurologic Examination
PubMed: 29843178
DOI: 10.1055/a-0590-4296 -
Brain and Nerve = Shinkei Kenkyu No... May 2021Rheumatoid meningitis, a central nervous system complication of rheumatoid arthritis, has low morbidity but poor prognosis without treatment. Contrast-enhanced meningeal...
Rheumatoid meningitis, a central nervous system complication of rheumatoid arthritis, has low morbidity but poor prognosis without treatment. Contrast-enhanced meningeal lesions on one side of the brain on MRI and hyperintensity of the pia mater on FLAIR image are characteristic features and should trigger the suspicion of rheumatoid meningitis. Steroids are effective for treatment, and good outcomes can be obtained through early diagnosis and intervention.
Topics: Arthritis, Rheumatoid; Brain; Humans; Magnetic Resonance Imaging; Meningitis
PubMed: 34006686
DOI: 10.11477/mf.1416201796 -
Current Opinion in Neurobiology Jun 2020In the past five years, the surrounding of the brain, that is the meninges (singular meninx) have evolved from being a physical barrier that protects the brain... (Review)
Review
In the past five years, the surrounding of the brain, that is the meninges (singular meninx) have evolved from being a physical barrier that protects the brain parenchyma to becoming a central player for both the maintenance of normal brain function and the modulation of neurological disorders. Indeed, the meninges are an immunologically active compartment that communicates with the periphery via the (re)discovered meningeal lymphatic system. From its ties to both the periphery and the central nervous system, the meninges are becoming a prevalent organ to understand and modulate brain homeostasis. Here we will focus on current advances in our understanding of the meningeal compartment with an emphasis on the meningeal lymphatic network as a key regulator.
Topics: Brain; Central Nervous System; Lymphatic System; Lymphatic Vessels; Meninges
PubMed: 31816570
DOI: 10.1016/j.conb.2019.11.010 -
Journal of the Neurological Sciences Aug 2016Hypertrophic Pachymeningitis (HP) denotes inflammation and thickening of the dura mater that can be idiopathic or secondary to a wide variety of conditions. Clinically,...
Hypertrophic Pachymeningitis (HP) denotes inflammation and thickening of the dura mater that can be idiopathic or secondary to a wide variety of conditions. Clinically, HP can present as debilitating headaches and cranial nerve defects but in other cases may be completely asymptomatic. We aimed to determine the relative incidence of different etiologies of HP and compare their associated imaging findings. Additionally, we sought to compare the clinical features of the underlying syndromes. We retrospectively examined twenty-two consecutive cases of HP seen in a single practitioner neurology practice over a ten-year time period. The most common etiologies were idiopathic HP and neurosarcoidosis. No imaging features were completely specific to any etiology. Nonetheless, idiopathic HP typically demonstrated diffuse regular enhancement whereas neurosarcoidosis was more likely to display a nodular enhancement pattern. Headache and cranial neuropathies were the most common clinical presentation. HP symptoms were often responsive to steroids but complete responses were rare. HP is a diagnostic challenge without specific findings on minimally or non-invasive diagnostic studies. Biopsy is often required and serves as the basis for effective therapy.
Topics: Adult; Aged; Biomarkers; Dura Mater; Female; Humans; Hypertrophy; Incidence; Magnetic Resonance Imaging; Male; Meningitis; Middle Aged; Retrospective Studies
PubMed: 27423604
DOI: 10.1016/j.jns.2016.06.024 -
World Neurosurgery May 2020Rheumatoid meningitis is a rare manifestation of autoimmune rheumatoid arthritis.
BACKGROUND
Rheumatoid meningitis is a rare manifestation of autoimmune rheumatoid arthritis.
CASE DESCRIPTION
A 70-year-old man with rheumatoid arthritis had presented with speech difficulties and limb weakness. Magnetic resonance imaging of his brain demonstrated diffuse meningeal enhancement. A biopsy confirmed the presence of rheumatoid meningitis.
CONCLUSION
In the present report, we have discussed the diagnostic and therapeutic approach to rheumatoid meningitis.
Topics: Aged; Arthritis, Rheumatoid; Biopsy; Brain; Humans; Magnetic Resonance Imaging; Male; Meningitis
PubMed: 32035199
DOI: 10.1016/j.wneu.2020.01.220 -
Acta Neurochirurgica Jan 2021
Topics: Arachnoid; Arachnoiditis; Arnold-Chiari Malformation; Humans; Syringomyelia
PubMed: 32948891
DOI: 10.1007/s00701-020-04584-3 -
FASEB Journal : Official Publication of... May 2022The lymphatic vasculature is a unidirectional network of lymphatic endothelial cells, whose main role is to maintain fluid homeostasis along with the absorption of... (Review)
Review
The lymphatic vasculature is a unidirectional network of lymphatic endothelial cells, whose main role is to maintain fluid homeostasis along with the absorption of dietary fat in the gastrointestinal organs and management and coordination of immune cell trafficking into lymph nodes during homeostasis and under inflammatory conditions. In homeostatic conditions, immune cells, such as dendritic cells, macrophages, or T cells can enter into the lymphatic vasculature and move easily through the lymph reaching secondary lymph nodes where immune cell activation or peripheral tolerance can be modulated. However, under inflammatory conditions such as pathogen infection, increased permeabilization of lymphatic vessels allows faster immune cell migration into inflamed tissues following a chemokine gradient, facilitating pathogen clearance and the resolution of inflammation. Interestingly, since the re-discovery of lymphatic vasculature in the central nervous system, known as the meningeal lymphatic vasculature, the role of these lymphatics as a key player in several neurological disorders has been described, with emphasis on the neurodegenerative process. Alternatively, less has been discussed about meningeal lymphatics and its role in neuroinflammation. In this review, we discuss current knowledge about the anatomy and function of the meningeal lymphatic vasculature and specifically analyze its contribution to different neuroinflammatory processes, highlighting the potential therapeutic target of meningeal lymphatic vasculature in these pathological conditions.
Topics: Endothelial Cells; Humans; Lymphatic System; Lymphatic Vessels; Meninges; Neuroinflammatory Diseases
PubMed: 35344212
DOI: 10.1096/fj.202101574RR -
Current Opinion in Neurobiology Apr 2023The spatial and temporal development of the brain, overlying meninges (fibroblasts, vasculature and immune cells) and calvarium are highly coordinated. In particular,... (Review)
Review
The spatial and temporal development of the brain, overlying meninges (fibroblasts, vasculature and immune cells) and calvarium are highly coordinated. In particular, the timing of meningeal fibroblasts into molecularly distinct pia, arachnoid and dura subtypes coincides with key developmental events in the brain and calvarium. Further, the meninges are positioned to influence development of adjacent structures and do so via depositing basement membrane and producing molecular cues to regulate brain and calvarial development. Here, we review the current knowledge of how meninges development aligns with events in the brain and calvarium and meningeal fibroblast "crosstalk" with these structures. We summarize outstanding questions and how the use of non-mammalian models to study the meninges will substantially advance the field of meninges biology.
Topics: Meninges; Dura Mater; Arachnoid; Brain
PubMed: 36773497
DOI: 10.1016/j.conb.2023.102676 -
Journal of the Neurological Sciences Apr 2020Central nervous system (CNS) metastasis from systemic cancers can involve the brain parenchyma, leptomeninges (pia, subarachnoid space and arachnoid mater), and dura.... (Review)
Review
Central nervous system (CNS) metastasis from systemic cancers can involve the brain parenchyma, leptomeninges (pia, subarachnoid space and arachnoid mater), and dura. Leptomeningeal metastases (LM), also known by different terms including neoplastic meningitis and carcinomatous meningitis, occur in both solid tumors and hematologic malignancies. This review will focus exclusively on LM arising from solid tumors with a goal of providing the reader an understanding of the epidemiology, pathophysiology, clinical presentation, prognostication, current management and future directions.
Topics: Arachnoid; Dura Mater; Humans; Meningeal Carcinomatosis; Meningeal Neoplasms; Meninges; Meningitis, Bacterial; Neoplasms
PubMed: 32007755
DOI: 10.1016/j.jns.2020.116706 -
European Journal of Immunology Sep 2023In the past 10 years, important discoveries have been made in the field of neuroimmunology, especially regarding brain borders. Indeed, meninges are protective envelopes... (Review)
Review
In the past 10 years, important discoveries have been made in the field of neuroimmunology, especially regarding brain borders. Indeed, meninges are protective envelopes surrounding the CNS and are currently in the spotlight, with multiple studies showing their involvement in brain infection and cognitive disorders. In this review, we describe the meningeal layers and their protective role in the CNS against bacterial, viral, fungal, and parasitic infections, by immune and nonimmune cells. Moreover, we discuss the neurological and cognitive consequences resulting from meningeal infections in neonates (e.g. infection with group B Streptococcus, cytomegalovirus, …) or adults (e.g. infection with Trypanosoma brucei, Streptococcus pneumoniae, …). We hope that this review will bring to light an integrated view of meningeal immune regulations during CNS infections and their neurological consequences.
Topics: Adult; Infant, Newborn; Humans; Meninges; Brain; Central Nervous System Infections; Streptococcus pneumoniae
PubMed: 37402972
DOI: 10.1002/eji.202250267