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Italian Journal of Pediatrics Oct 2023Human Parechovirus is a common cause of infection occurring especially during the first years of life. It may present with a broad spectrum of manifestations, ranging... (Review)
Review
Human Parechovirus is a common cause of infection occurring especially during the first years of life. It may present with a broad spectrum of manifestations, ranging from a pauci-symptomatic infection to a sepsis-like or central nervous system disease. Aim of this study is to explore the knowledge on Parechovirus meningitis. According to the purpose of the study, a systematic review of the literature focusing on reports on central nervous system. Parechovirus infection of children was performed following PRISMA criteria. Out of the search, 304 papers were identified and 81 records were included in the revision dealing with epidemiology, clinical manifestations, laboratory findings, imaging, therapy and outcome. Parechovirus meningitis incidence may vary all over the world and outbreaks may occur. Fever is the most common symptom, followed by other non-specific signs and symptoms including irritability, poor feeding, skin rash or seizures. Although several reports describe favourable short-term neurodevelopmental outcomes at discharge after Parechovirus central nervous system infection, a specific follow up and the awareness on the risk of sequelae should be underlined in relation to the reported negative outcome. Evidence seems to suggest a correlation between magnetic imaging resonance alteration and a poor outcome.
Topics: Humans; Child; Infant; Parechovirus; Picornaviridae Infections; Meningitis; Sepsis; Central Nervous System Infections
PubMed: 37880789
DOI: 10.1186/s13052-023-01550-4 -
World Neurosurgery Aug 2023Microsurgical dissection of arachnoid cisterns requires a combination of anatomic knowledge and microsurgical skill. The latter relies on experience and microsurgical...
BACKGROUND
Microsurgical dissection of arachnoid cisterns requires a combination of anatomic knowledge and microsurgical skill. The latter relies on experience and microsurgical dexterity, which depend on visual identification of cisternal microvasculature. We describe a novel standardized operative sequence to allow for bloodless arachnoid dissection when cisternal anatomy is challenging.
METHODS
We used the reported technique in 1928 cases over the past 5 years (2018-2022). The outer arachnoid was incised to enter the cisternal space. A cotton pledget was placed in contact with an inner membrane and gently pushed laterally and superficially with the suction cannula at medium suction power. When the arachnoid membranes dried, arachnoid trabeculae were cut and microvasculature were released at the convexity of their loops and gently transposed off the dissection trajectory. The same principle was used to release parent and perforating arteries from the aneurysm dome.
RESULTS
The microcisternal drainage technique enabled safe and efficient access through adhered arachnoid in all cases. A complex anterior communicating artery aneurysm in a 52-year-old lady demonstrated the use of the microcisternal drainage technique during access through the pericallosal cistern. This technique was used in all cases where cisternal dissection was needed.
CONCLUSIONS
The microcisternal drainage technique uses deliberate and strategic suction, dynamic retraction, and nuanced scissor cuts to enable precise and bloodless microdissection of adherent arachnoid cisterns. This technique combines common neurosurgical maneuvers in a novel standardized sequence to improve efficiency and safety during arachnoid dissection.
Topics: Female; Humans; Middle Aged; Subarachnoid Space; Arachnoid; Microsurgery; Intracranial Aneurysm; Drainage
PubMed: 37105274
DOI: 10.1016/j.wneu.2023.04.087 -
European Journal of Clinical... Dec 2023Little is known on headaches long-term persistence after bacterial meningitis and on their impact on patients' quality of life.
BACKGROUND
Little is known on headaches long-term persistence after bacterial meningitis and on their impact on patients' quality of life.
METHODS
In an ancillary study of the French national prospective cohort of community-acquired bacterial meningitis in adults (COMBAT) conducted between February 2013 and July 2015, we collected self-reported headaches before, at onset, and 12 months (M12) after meningitis. Determinants of persistent headache (PH) at M12, their association with M12 quality of life (SF 12), depression (Center for Epidemiologic Studies Depression Scale) and neuro-functional disability were analysed.
RESULTS
Among the 277 alive patients at M12 87/274 (31.8%), 213/271 (78.6%) and 86/277 (31.0%) reported headaches before, at the onset, and at M12, respectively. In multivariate analysis, female sex (OR: 2.75 [1.54-4.90]; p < 0.001), pre-existing headaches before meningitis (OR: 2.38 [1.32-4.30]; p < 0.01), higher neutrophilic polynuclei percentage in the CSF of the initial lumbar puncture (OR: 1.02 [1.00-1.04]; p < 0.05), and brain abscess during the initial hospitalisation (OR: 8.32 [1.97-35.16]; p < 0.01) were associated with M12 persistent headaches. Neither the responsible microorganism, nor the corticoids use were associated with M12 persistent headaches. M12 neuro-functional disability (altered Glasgow Outcome Scale; p < 0.01), M12 physical handicap (altered modified Rankin score; p < 0.001), M12 depressive symptoms (p < 0.0001), and M12 altered physical (p < 0.05) and mental (p < 0.0001) qualities of life were associated with M12 headaches.
CONCLUSION
Persistent headaches are frequent one year after meningitis and are associated with quality of life alteration.
CLINICAL TRIAL
NCT01730690.
Topics: Adult; Humans; Female; Quality of Life; Prevalence; Prospective Studies; Meningitis, Bacterial; Headache
PubMed: 37867184
DOI: 10.1007/s10096-023-04673-y -
Science Immunology Oct 2023High neonatal susceptibility to meningitis has been attributed to the anatomical barriers that act to protect the central nervous system (CNS) from infection being...
High neonatal susceptibility to meningitis has been attributed to the anatomical barriers that act to protect the central nervous system (CNS) from infection being immature and not fully developed. However, the mechanisms by which pathogens breach CNS barriers are poorly understood. Using the Armstrong strain of lymphocytic choriomeningitis virus (LCMV) to study virus propagation into the CNS during systemic infection, we demonstrate that mortality in neonatal, but not adult, mice is high after infection. Virus propagated extensively from the perivenous sinus region of the dura mater to the leptomeninges, choroid plexus, and cerebral cortex. Although the structural barrier of CNS border tissues is comparable between neonates and adults, immunofluorescence staining and single-cell RNA sequencing analyses revealed that the neonatal dural immune cells are immature and predominantly composed of CD206 macrophages, with major histocompatibility complex class II (MHCII) macrophages being rare. In adults, however, perivenous sinus immune cells were enriched in MHCII macrophages that are specialized for producing antiviral molecules and chemokines compared with CD206 macrophages and protected the CNS against systemic virus invasion. Our findings clarify how systemic pathogens enter the CNS through its border tissues and how the immune barrier at the perivenous sinus region of the dura blocks pathogen access to the CNS.
Topics: Mice; Animals; Central Nervous System; Meningoencephalitis; Lymphocytic Choriomeningitis; Meninges; Lymphocytic choriomeningitis virus; Meningitis, Viral; Encephalitis, Viral
PubMed: 37801517
DOI: 10.1126/sciimmunol.adg6155 -
Journal of Neuro-ophthalmology : the... Sep 2023Neurocysticercosis (NCC) is the most common parasitic infection of the central nervous system and is typically diagnosed through visualization of the cysts in the...
BACKGROUND
Neurocysticercosis (NCC) is the most common parasitic infection of the central nervous system and is typically diagnosed through visualization of the cysts in the cerebral parenchyma by neuro-imaging. However, neuro-imaging may not detect extraparenchymal neurocysticercosis (EPNCC), which is a rare manifestation of the disease involving the subarachnoid, meningeal, and intraventricular spaces. We report 2 cases of extraparenchymal neurocysticercosis, and discuss the diagnostic challenges and management of this entity.
METHODS
Two cases were identified through clinical records.
RESULTS
Both patients had an insidious onset with slow progression of disease, and presented with papilledema and cerebrospinal fluid (CSF) eosinophilia. One case was diagnosed with spinal cord biopsy. The other was diagnosed with CSF serology and next-generation sequencing-based pathogen analysis. Both patients were treated with ventriculoperitoneal shunt, systemic antiparasitic agents, and immunosuppression.
CONCLUSIONS
EPNCC is less common than parenchymal NCC. A high level of clinical suspicion is required given its rarity, long incubation period, and slow progression. Diagnosis and treatment can be challenging and requires a multidisciplinary approach.
Topics: Humans; Neurocysticercosis; Magnetic Resonance Imaging; Ventriculoperitoneal Shunt; Subarachnoid Space; Central Nervous System
PubMed: 36637411
DOI: 10.1097/WNO.0000000000001782 -
Frontiers in Immunology 2023Tuberculous meningitis (TBM), the most severe form of tuberculosis, causes death in approximately 25% cases despite antibiotic therapy, and half of survivors are left... (Review)
Review
Tuberculous meningitis (TBM), the most severe form of tuberculosis, causes death in approximately 25% cases despite antibiotic therapy, and half of survivors are left with neurological disability. Mortality and morbidity are contributed to by a dysregulated immune response, and adjunctive host-directed therapies are required to modulate this response and improve outcomes. Developing such therapies relies on improved understanding of the host immune response to TBM. The historical challenges in TBM research of limited and models have been partially overcome by recent developments in proteomics, transcriptomics, and metabolomics, and the use of these technologies in nested substudies of large clinical trials. We review the current understanding of the human immune response in TBM. We begin with entry into the central nervous system (CNS), microglial infection and blood-brain and other CNS barrier dysfunction. We then outline the innate response, including the early cytokine response, role of canonical and non-canonical inflammasomes, eicosanoids and specialised pro-resolving mediators. Next, we review the adaptive response including T cells, microRNAs and B cells, followed by the role of the glutamate-GABA neurotransmitter cycle and the tryptophan pathway. We discuss host genetic immune factors, differences between adults and children, paradoxical reaction, and the impact of HIV-1 co-infection including immune reconstitution inflammatory syndrome. Promising immunomodulatory therapies, research gaps, ongoing challenges and future paths are discussed.
Topics: Adult; Child; Humans; Tuberculosis, Meningeal; MicroRNAs; Central Nervous System; Mycobacterium tuberculosis; B-Lymphocytes
PubMed: 38264653
DOI: 10.3389/fimmu.2023.1326651 -
Neurobiology of Disease Dec 2023Cerebral small vessel disease (CSVD) causes 20%-25% of stroke and contributes to 45% of dementia cases worldwide. However, since its early symptoms are inconclusive in... (Review)
Review
Cerebral small vessel disease (CSVD) causes 20%-25% of stroke and contributes to 45% of dementia cases worldwide. However, since its early symptoms are inconclusive in addition to the complexity of the pathological basis, there is a rather limited effective therapies and interventions. Recently, accumulating evidence suggested that various brain-waste-clearance dysfunctions are closely related to the pathogenesis and prognosis of CSVD, and after a comprehensive and systematic review we classified them into two broad categories: trans-barrier transport and lymphatic drainage. The former includes blood brain barrier and blood-cerebrospinal fluid barrier, and the latter, glymphatic-meningeal lymphatic system and intramural periarterial drainage pathway. We summarized the concepts and potential mechanisms of these clearance systems, proposing a relatively complete framework for elucidating their interactions with CSVD. In addition, we also discussed recent advances in therapeutic strategies targeting clearance dysfunction, which may be an important area for future CSVD research.
Topics: Humans; Blood-Brain Barrier; Glymphatic System; Stroke; Cerebral Small Vessel Diseases; Meninges; Brain
PubMed: 37951367
DOI: 10.1016/j.nbd.2023.106347 -
The Journal of Experimental Medicine Apr 2024Leptomeningeal metastasis (LM), or spread of cancer to the cerebrospinal fluid (CSF)-filled space surrounding the central nervous system, is a fatal complication of... (Review)
Review
Leptomeningeal metastasis (LM), or spread of cancer to the cerebrospinal fluid (CSF)-filled space surrounding the central nervous system, is a fatal complication of cancer. Entry into this space poses an anatomical challenge for cancer cells; movement of cells between the blood and CSF is tightly regulated by the blood-CSF barriers. Anatomical understanding of the leptomeninges provides a roadmap of corridors for cancer entry. This Review describes the anatomy of the leptomeninges and routes of cancer spread to the CSF. Granular understanding of LM by route of entry may inform strategies for novel diagnostic and preventive strategies as well as therapies.
Topics: Meninges; Central Nervous System
PubMed: 38451255
DOI: 10.1084/jem.20212121 -
International Journal of Rheumatic... Sep 2023Our understanding of IgG4-RD and pachymeningitis has grown substantially, but the optimal approach for diagnosis, management, and long-term outcomes is still an area of...
OBJECTIVE
Our understanding of IgG4-RD and pachymeningitis has grown substantially, but the optimal approach for diagnosis, management, and long-term outcomes is still an area of uncertainty.
METHODS
HUVAC is a database for IgG4-RD patients, this database was retrospectively evaluated for pachymeningeal disease. Demographic, clinical, serological, imaging, histopathological data, and treatment details were re-interpreted in patients with pachymeningitis.
RESULTS
Among 97 patients with IgG4-RD, 6 (6.2%) had pachymeningitis. None of these patients had extracranial features, and also, in most of the patients, serum IgG4 levels were normal. Tentorium cerebelli and transverse sinus dura were the most commonly involved in the posterior fossa. During 18 months of median follow-up on steroid+-rituximab, none of them relapsed as pachymeningitis.
CONCLUSION
Our patients were mainly older males with sole neurological involvement. Non-specific headache was the most common manifestation, and serum IgG4 levels were not useful for diagnosis. Typical radiology and tentorial thickening should suggest IgG4-RD and prompt an early biopsy. Moreover, accompanying hypophysitis could also be a clue. With steroids+ rituximab treatment, no relapse related to meningeal involvement was seen in long-term follow-up.
Topics: Male; Humans; Immunoglobulin G; Immunoglobulin G4-Related Disease; Follow-Up Studies; Rituximab; Retrospective Studies; Meningitis
PubMed: 37403944
DOI: 10.1111/1756-185X.14725 -
Antimicrobial Agents and Chemotherapy Oct 2023() is an encapsulated neurotropic fungal pathogen and the causative agent of cryptococcal meningoencephalitis (CME) in humans. Recommended treatment for CME is...
() is an encapsulated neurotropic fungal pathogen and the causative agent of cryptococcal meningoencephalitis (CME) in humans. Recommended treatment for CME is Amphotericin B (AmpB) and 5-fluorocytosine (5-FC). Though effective, AmpB has displayed numerous adverse side effects due to its potency and nephrotoxicity, prompting investigation into alternative treatments. Palmitoylethanolamide (PEA) is an immunomodulatory compound capable of promoting neuroprotection and reducing inflammation. To investigate the efficacy of PEA as a therapeutic alternative for CME, we intracerebrally infected mice with and treated them with PEA or AmpB alone or in combination. Our results demonstrate that PEA alone does not significantly prolong survival nor reduce fungal burden, but when combined with AmpB, PEA exerts an additive effect and promotes both survivability and fungal clearance. However, we compared this combination to traditional AmpB and 5-FC treatment in a survivability study and observed lower efficacy. Overall, our study revealed that PEA alone is not effective as an antifungal agent in the treatment of CME. Importantly, we describe the therapeutic capability of PEA in the context of infection and show that its immunomodulatory properties may confer limited protection when combined with an effective fungicidal agent.
Topics: Humans; Mice; Animals; Meningitis, Cryptococcal; Antifungal Agents; Cryptococcus neoformans; Cryptococcosis; Amphotericin B; Flucytosine; Meningoencephalitis
PubMed: 37750714
DOI: 10.1128/aac.00459-23