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The American Journal of Tropical... Jul 2021Neurocysticercosis (NCC) is endemic in many parts of the world, carrying significant neurological morbidity that varies according to whether lesions are located inside...
Neurocysticercosis (NCC) is endemic in many parts of the world, carrying significant neurological morbidity that varies according to whether lesions are located inside the cerebral parenchyma or in extraparenchymal spaces. The latter, in particular subarachnoid NCC, is assumed to be more severe, but no controlled studies comparing mortality between types of NCC exist. The aim of this study was to compare all-cause mortality between patients with intraparenchymal NCC and those with subarachnoid NCC. Vital status and sociodemographic characteristics were evaluated in patients with intraparenchymal viable, intraparenchymal calcified, and subarachnoid NCC attending a neurological referral hospital in Lima, Perú. Survival analyses using Kaplan-Meier curves and Cox proportional regression models were carried out to compare mortality rates between groups. From 840 NCC patients followed by a median time of 82.3 months, 42 (5.0%) died, six (1.8%) in the intraparenchymal viable group, four (1.3%) in the calcified group, and 32 (16.6%) in the subarachnoid group (P < 0.001). Older age and lower education were significantly associated with mortality. The age-adjusted hazard ratio for death in the subarachnoid group was 13.6 (95% CI: 5.6-33.0, P < 0.001) compared with the intraparenchymal viable group and 10.7 (95% CI: 3.7-30.8, P < 0.001) when compared with the calcified group. We concluded that subarachnoid disease is associated with a much higher mortality in NCC.
Topics: Adult; Animals; Female; Humans; Male; Middle Aged; Neurocysticercosis; Subarachnoid Space; Taenia solium
PubMed: 34232912
DOI: 10.4269/ajtmh.20-1330 -
Fluids and Barriers of the CNS Dec 2022Cerebrospinal fluid (CSF) is an essential and critical component of the central nervous system (CNS). According to the concept of the "third circulation" originally... (Review)
Review
Cerebrospinal fluid (CSF) is an essential and critical component of the central nervous system (CNS). According to the concept of the "third circulation" originally proposed by Cushing, CSF is mainly produced by the choroid plexus and subsequently leaves the cerebral ventricles via the foramen of Magendie and Luschka. CSF then fills the subarachnoid space from whence it disperses to all parts of the CNS, including the forebrain and spinal cord. CSF provides buoyancy to the submerged brain, thus protecting it against mechanical injury. CSF is also transported via the glymphatic pathway to reach deep interstitial brain regions along perivascular channels; this CSF clearance pathway promotes transport of energy metabolites and signaling molecules, and the clearance of metabolic waste. In particular, CSF is now intensively studied as a carrier for the removal of proteins implicated in neurodegeneration, such as amyloid-β and tau. Despite this key function of CSF, there is little information about its production rate, the factors controlling CSF production, and the impact of diseases on CSF flux. Therefore, we consider it to be a matter of paramount importance to quantify better the rate of CSF production, thereby obtaining a better understanding of CSF dynamics. To this end, we now review the existing methods developed to measure CSF production, including invasive, noninvasive, direct, and indirect methods, and MRI-based techniques. Depending on the methodology, estimates of CSF production rates in a given species can extend over a ten-fold range. Throughout this review, we interrogate the technical details of CSF measurement methods and discuss the consequences of minor experimental modifications on estimates of production rate. Our aim is to highlight the gaps in our knowledge and inspire the development of more accurate, reproducible, and less invasive techniques for quantitation of CSF production.
Topics: Central Nervous System; Glymphatic System; Brain; Subarachnoid Space; Cerebral Ventricles; Cerebrospinal Fluid
PubMed: 36522656
DOI: 10.1186/s12987-022-00382-4 -
Child's Nervous System : ChNS :... Jul 2020Quadrigeminal arachnoid cyst (QAC) associated with encephalocele is rare; and while some treatments have been developed in recent years, no definite therapeutic approach... (Review)
Review
INTRODUCTION
Quadrigeminal arachnoid cyst (QAC) associated with encephalocele is rare; and while some treatments have been developed in recent years, no definite therapeutic approach for QAC has been established. Endoscopic treatment for arachnoid cyst is gaining popularity because it is relatively less invasive to the normal brain tissues.
CASE PRESENTATION
The patient, a 4-year-old girl, presented with QAC associated with congenital occipital encephalocele. At the age of 1 month, repair of the perinatal encephalocele had been performed at another institute. An asymptomatic arachnoid cyst remained in the posterior fossa, which was closely monitored with follow up. At age 4 years, the patient started to complain of headache, which gradually increased in both strength and frequency. Magnetic resonance imaging (MRI) revealed cerebellar compression due to cyst enlargement. We performed neuroendoscopic cyst fenestration with an occipital bone approach. Post-operative MRI showed reduced size of the cyst, and the headache dramatically improved and resolved.
DISCUSSION
The standard treatment of QAC is still controversial; however, our successful use of endoscopic fenestration toward the third ventricle indicates its efficacy and safety. QACs have been classified into 3 types based on their expansion mechanisms; our case might suggest another possible mechanism of QAC development.
CONCLUSION
In our case, endoscopic cyst fenestration was successful for QAC with perinatal encephalocele. However, long-term follow-up and analysis of similar cases are needed to determine its effectiveness.
Topics: Arachnoid Cysts; Child, Preschool; Encephalocele; Female; Humans; Magnetic Resonance Imaging; Neuroendoscopy; Third Ventricle
PubMed: 32328704
DOI: 10.1007/s00381-020-04626-2 -
Journal of Neuroendovascular Therapy 2020The cavernous sinus (CS) is a parasellar dural envelope containing an important venous pathway. The venous channels, which have an endothelial layer and no smooth muscle... (Review)
Review
The cavernous sinus (CS) is a parasellar dural envelope containing an important venous pathway. The venous channels, which have an endothelial layer and no smooth muscle layer, are located in connective tissue. In the early embryonic stages, the neural tube is surrounded by the primitive capillary plexus and undifferentiated mesenchymal tissue, the primary meninx, and initially drains into the primary head sinus (PHS) through the anterior, middle, and posterior dural plexus (ADP, MDP, and PDP). Subsequently, following enlargement of the brain and differentiation of the mesenchyme, two major primary sinuses, the pro-otic sinus and the primitive tentorial sinus, become prominent. The pro-otic sinus is the remnant of the short segment of the PHS cranial to the MDP and the stem of the MDP. The CS originates from the plexiform channels medial to the trigeminal ganglion, namely the medial tributaries of the pro-otic sinus. The stem of the pia-arachnoidal vein draining into the ADP represents the primitive tentorial sinus. It is considerably elongated due to expansion of the cerebral hemisphere, and migrates medially toward the CS. The morphological changes in the CS and primitive tentorial sinus exhibit considerable variation in cerebral venous drainage patterns. Embryological knowledge facilitates interpretation of the anatomy of the CS, and it is useful to perform safe and beneficial endovascular treatment for the CS.
PubMed: 37502138
DOI: 10.5797/jnet.ra.2020-0052 -
Cureus Mar 2023Arachnoid cysts are relatively rare and usually asymptomatic. It can only be diagnosed through radiological imaging modalities. Some patients may develop symptoms such...
Arachnoid cysts are relatively rare and usually asymptomatic. It can only be diagnosed through radiological imaging modalities. Some patients may develop symptoms such as seizures, headache, dizziness, or psychiatric symptoms. We present a case of a 25-year-old male, previously healthy, who presented with sudden, repetitive episodes of seizure without regaining his consciousness. Computed tomography (CT) head scan showed a large cystic lesion that showed a rightward midline shift. Treatment was done surgically via endoscopic fenestration, and the patient remained symptom-free for one year. Most arachnoid cysts tend to remain asymptomatic throughout a patient's life span, allowing them to lead everyday normal lives; however, when these symptoms surface, they tend to be of a sudden nature requiring urgent surgical intervention. Our report follows the case of a young patient whose symptoms appear suddenly with triggers that led to status epilepticus. Our patient continued to suffer from multiple seizure attacks despite being on multiple anti-convulsive medications, and his symptoms eventually subsided via surgical intervention.
PubMed: 37102020
DOI: 10.7759/cureus.36552 -
BMC Neurology Apr 2021The physiological and pathological significance of the arachnoid membrane (AM) is still unknown. In this study, we investigated various characteristics of the AM,... (Observational Study)
Observational Study
BACKGROUND
The physiological and pathological significance of the arachnoid membrane (AM) is still unknown. In this study, we investigated various characteristics of the AM, focusing on the influence of inflammation and fibrosis.
METHODS
Small pieces of AM sample were obtained during neurosurgical procedures from 74 cases. The clinical and pathological characteristics of the hyperplastic AM group (≥ 50 μm) and the non-hyperplastic AM group (< 50 μm) were compared. Then, potential correlations between AM thickness and clinical characteristics were analyzed. Moreover, VEGFα, TGFβ, and TGFα levels were quantitated by real time PCR. Then, the potential correlations between AM thickness and these inflammatory or anti-inflammatory markers, and the influence of the original disease were calculated.
RESULTS
The median age of the patients in hyperplastic AM group was significantly older than that of the non-hyperplastic AM group. Moreover, the number of fibroblasts, CD68 cells, CD86 cells, and CD206 cells in the hyperplastic AM group was significantly higher than that in the non-hyperplastic AM group. The AM thickness was significantly correlated to age and number of fibroblasts, CD68 cells, CD86 cells, and CD206 cells. The thickness of the AM was significantly correlated to the messenger RNA expression levels of VEGFα (ρ = 0.337), and the VEGFα expression levels were significantly correlated with TGFβ and TNFα.
CONCLUSIONS
The AM hyperplasia was influenced by aging and could be a result of inflammation and fibrosis through cytokine secretion from the inflammatory cells and fibroblasts in the AM.
Topics: Adult; Aged; Aging; Arachnoid; Female; Fibrosis; Humans; Inflammation; Male; Middle Aged
PubMed: 33882882
DOI: 10.1186/s12883-021-02202-y -
Arquivos de Neuro-psiquiatria Mar 2020At the beginning of the 20th century, cerebrospinal fluid (CSF) collection and analysis emerged as a promising aid in the diagnosis of diseases of the central nervous...
At the beginning of the 20th century, cerebrospinal fluid (CSF) collection and analysis emerged as a promising aid in the diagnosis of diseases of the central nervous system. It was obtained through the established procedure of lumbar puncture, described by Heinrich Quinke in 1891. The search for an alternative way to gather the CSF emerged in animal research, highlighting the cisterna magna as a promising source, with relative safety when performed by someone trained. Described initially and in detail by James Ayer in 1920, the procedure was widely adopted by neurologists and psychiatrists at the time, featuring its multiple advantages and clinical applications. After a period of great procedure use and exponential data collection, its complications and risks relegated the puncture of the cisterna magna as an alternative route that causes fear and fascination in modern Neurology.
Topics: Animals; Cerebrospinal Fluid; Cisterna Magna; History, 19th Century; History, 20th Century; Punctures; Spinal Puncture
PubMed: 32215456
DOI: 10.1590/0004-282X20190142 -
Journal of Fungi (Basel, Switzerland) Nov 2022Coccidioidomycosis meningitis (CM) is the most aggressive form of coccidioidomycosis, requiring lifelong antifungal treatment and often cerebrospinal fluid (CSF)...
Coccidioidomycosis meningitis (CM) is the most aggressive form of coccidioidomycosis, requiring lifelong antifungal treatment and often cerebrospinal fluid (CSF) diversion. Long-standing CM can be associated with spinal complications such as arachnoiditis. However, studies describing the frequency, clinical, and imaging characteristics of arachnoiditis in patients with CM are limited. We identified 133 patients with CM based on CSF culture, PCR, or serology between January 2010 and December 2020. Of these, 37 patients underwent spinal imaging. Data on demographics, risk factors, symptoms, antifungal therapy, surgical management, follow-up visits, adherence, serological trends, and imaging findings were reviewed. Abnormal findings were observed in 30 of the 37 patients with CM who underwent spinal imaging. The imaging abnormalities noted in our study included leptomeningeal enhancement (53%), arachnoiditis (53%), syringomyelia (23%), cord signal abnormalities (10%), and osteomyelitis (7%). Of the 30 patients, 90% had symptoms, such as weakness, numbness, or urinary retention. The incidence of arachnoiditis in the present study was 12%. Higher initial CSF protein levels and intra cranial pressure were associated with a higher risk of developing arachnoiditis/syringomyelia. Management of CM was challenging, as evidenced by shunt failure (46%), medication non-compliance (57%), and lack of adequate follow-up (60%). Persistent disabilities were noted in 62% of the patients. Patients with CM develop spinal complications such as arachnoiditis, or syringomyelia. Many cases may go undetected due to lack of symptoms in early stages. CM management challenges such as shunt failure, lack of follow-up care, and medication noncompliance, were frequent.
PubMed: 36354947
DOI: 10.3390/jof8111180 -
Surgical Neurology International 2022Spinal arachnoid cysts (SAC) are typically congenital, spontaneous, traumatic (i.e., including iatrogenic/surgical), or inflammatory in origin. In descending order, they... (Review)
Review
BACKGROUND
Spinal arachnoid cysts (SAC) are typically congenital, spontaneous, traumatic (i.e., including iatrogenic/surgical), or inflammatory in origin. In descending order, they occur in the thoracic, lumbar, and cervical spine, and originate from focal entrapment of the arachnoid membrane. Arachnoid cysts represent 1-2% of all cystic spinal masses/tumors. The majority are extradural arachnoid cysts (EDAC) while 10% of all arachnoid cysts are intradural (IDAC) including subarachnoid, or extra-arachnoidal/subdural. Only rarely are they intramedullary in location. The clinical symptoms/signs of IDAC/EDAC include; intracranial hypotension (i.e., due to continued cerebrospinal fluid drainage), radiculopathy, and/or myelopathy.
METHODS
Magnetic Resonance Images (MR) and Myelo-Computed Tomography (Myelo-CT) studies classically document the predominant dorsal location of IDAC/EDAC. They also show their extent and severity contributing to root, cord, and/or cauda equina compression. In the cervical/thoracic spine, MR/Myelo-CT studies classically show the "double cord" or "windsock" signs, while the "fake arachnoiditis sign" may be seen in the lumbar spine. The latter sign signals the presence of a circumferential extra-arachnoidal-subdural cyst that centrally "traps" the cauda equina. Note, that this resembles and is often misinterpreted as adhesive archnoiditis.
RESULTS
Patients with significant SAC-related neurological deficits typically warrant early surgery. That surgery includes; partial/total resection/fenestration of cyst walls, and occlusion of communicating fistulas with or without accompanying shunts.
CONCLUSION
It is critical to recognize the clinical (i.e., intracranial hypotension, radiculopathy, and/or myelopathy) and radiographic MR/Myelo-CT signs (i.e., "double cord," "windsock signs", or "fake arachnoiditis sign") of IDAC, EDAC, or intramedullary spinal arachnoid cysts to appropriately offer treatment. For those with significant neurological deficits, early surgery (i.e. optimally 0-< 24 hours after the onset of symptoms/signs consisting of laminectomies, partial/total cyst resection/fenestration, and ligation/occlusion of the subarachnoid-cyst fistula with or without shunt placement), is essential to avoid significant permanent neurological sequelae.
PubMed: 35399888
DOI: 10.25259/SNI_153_2022 -
Arquivos de Neuro-psiquiatria Jun 2023
Topics: Humans; Arachnoiditis; Hydrocephalus
PubMed: 37379872
DOI: 10.1055/s-0043-1768159