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Frontiers in Neurology 2023Relapsing polychondritis (RP) is a rare rheumatologic disorder that may affect the neurological system with various presentations. In this study, we present a case and...
BACKGROUND AND PURPOSE
Relapsing polychondritis (RP) is a rare rheumatologic disorder that may affect the neurological system with various presentations. In this study, we present a case and summarize the clinical characteristics of RP-associated meningoencephalitis.
CASE PRESENTATION
A 48-year-old man presented with first-ever seizures that were well controlled by valproate. Physical examination results were unremarkable, except for binaural deformation. The initial brain magnetic resonance imaging (MRI) without contrast and electroencephalogram (EEG) findings were normal. However, the patient subsequently developed recurrent fever, scleritis, headache, lethargy, and left arm paresis. Repeated brain MRI with contrast demonstrated increased enhancement of the pia mater and abnormal diffusion-weighted imaging (DWI) signals in the bilateral auricles. The cerebrospinal fluid (CSF) analysis showed 2 leukocytes/μL, 736.5 mg/L of protein, and no evidence of infectious disease or autoimmune encephalitis. Meningoencephalitis secondary to RP was considered. The patient's condition improved significantly and quickly with the administration of dexamethasone (10 mg per day). Oral methylprednisolone was continued, and the patient remained well without relapse during the 9-month follow-up period.
CONCLUSION
RP-associated meningoencephalitis is rare but fatal. Although symptoms vary, red or deformed ears remain the most common and suggestive features. Non-specific parenchymal changes and/or meningeal enhancement can be observed on brain MRI scans. CSF lymphocytic pleocytosis with mild protein elevation was observed in most patients.
PubMed: 38033767
DOI: 10.3389/fneur.2023.1265345 -
Zhurnal Nevrologii I Psikhiatrii Imeni... 2023The article represents the translation of chapters of the scientific work «Onomatologia anatomica» (1880) by the Austrian anatomist Josef Hyrtl devoted to terminology...
The article represents the translation of chapters of the scientific work «Onomatologia anatomica» (1880) by the Austrian anatomist Josef Hyrtl devoted to terminology in the anatomy of the meninges, namely , , , .
Topics: Humans; Meninges; Terminology as Topic; Translations
PubMed: 37994897
DOI: 10.17116/jnevro2023123111117 -
Journal of Anatomy Mar 2024In humans and most mammals, there is a notch-like portal, the foramen of Luschka (or lateral foramen), which connects the lumen of the fourth ventricle with the subdural...
In humans and most mammals, there is a notch-like portal, the foramen of Luschka (or lateral foramen), which connects the lumen of the fourth ventricle with the subdural space. Gross dissection, light and scanning electron microscopy, and μCT analysis revealed the presence of a foramen of Luschka in the American alligator (Alligator mississippiensis). In this species, the foramen of Luschka is a notch in the dorsolateral wall of the pons immediately caudal to the peduncular base of the cerebellum, near the rostral end of the telovelar membrane over the fourth ventricle. At the foramen of Luschka there was a transition from a superficial pia mater lining to a deep ependymal lining. There was continuity between the lumen of the fourth ventricle and the subdural space, via the foramen of Luschka. This anatomical continuity was further demonstrated by injecting Evans blue into the lateral ventricle which led to extravasation through the foramen of Luschka and pooling of the dye on the lateral surface of the brain. Simultaneous subdural and intraventricular recordings of cerebrospinal fluid (CSF) pressures revealed a stable agreement between the two pressures at rest. Perturbation of the system allowed for static and dynamic differences to develop, which could indicate varying flow patterns of CSF through the foramen of Luschka.
Topics: Animals; Humans; Alligators and Crocodiles; Subdural Space; Cerebellum; Fourth Ventricle; Ependyma; Mammals
PubMed: 37965891
DOI: 10.1111/joa.13972 -
Biomaterials Advances Dec 2023Leptomeningeal metastasis (LM) occurs when cancer cells infiltrate the subarachnoid space (SAS) and metastasize to the fibrous structures that surround the brain and...
Leptomeningeal metastasis (LM) occurs when cancer cells infiltrate the subarachnoid space (SAS) and metastasize to the fibrous structures that surround the brain and spinal cord. These structures include the leptomeninges (i.e., the pia mater and arachnoid mater), as well as subarachnoid trabeculae, which are collagen-rich fibers that provide mechanical structure for the SAS, support resident cells, and mediate flow of cerebrospinal fluid (CSF). Although there is a strong expectation that the presence of fibers within the SAS influences LM to be a major driver of tumor progression and lethality, exactly how trabecular architecture relates to the process of metastasis in cancer is poorly understood. This lack of understanding is likely due in part to the difficulty of accessing and manipulating this tissue compartment in vivo. Here, we utilized electrospun polycaprolactone (PCL) to produce structures bearing remarkable morphological similarity to native SAS fiber architecture. First, we profiled the native architecture of leptomeningeal and trabecular fibers collected from rhesus macaque monkeys, evaluating both qualitative and quantitative differences in fiber ultrastructure for various regions of the CNS. We then varied electrospinning parameters to produce a small library of PCL scaffolds possessing distinct architectures mimicking the range of fiber properties observed in vivo. For proof of concept, we studied the metastasis-related behaviors of human pediatric medulloblastoma cells cultured in different fiber microenvironments. These studies demonstrated that a more open, porous fiber structure facilitates DAOY cell spread across and infiltration into the meningeal mimic. Our results present a new tissue engineered model of the subarachnoid space and affirm the expectation that fiber architecture plays an important role in mediating metastasis-related behaviors in an in vitro model of pediatric medulloblastoma.
Topics: Animals; Child; Humans; Medulloblastoma; Macaca mulatta; Subarachnoid Space; Cerebellar Neoplasms; Tumor Microenvironment
PubMed: 37918168
DOI: 10.1016/j.bioadv.2023.213646 -
European Heart Journal. Acute... Nov 2023The role of coronary calcification on clinical outcomes among different revascularization strategies in patients presenting with acute coronary syndromes (ACSs) has been...
AIMS
The role of coronary calcification on clinical outcomes among different revascularization strategies in patients presenting with acute coronary syndromes (ACSs) has been rarely investigated. The aim of this investigation is to evaluate the role of coronary calcification, detected by coronary angiography, in the whole spectrum of patients presenting with acute ACS.
METHODS AND RESULTS
The present study was a post hoc analysis of the MATRIX programme. The primary endpoint was major adverse cardiovascular events (MACE), defined as the composite of all-cause mortality, myocardial infarction (MI), or stroke up to 365 days. Among the 8404 patients randomized in the MATRIX trial, data about coronary calcification were available in 7446 (88.6%) and therefore were included in this post hoc analysis. Overall, 875 patients (11.7%) presented with severe coronary calcification, while 6571 patients (88.3%) did not present severe coronary calcification on coronary angiography. Fewer patients with severe coronary calcification underwent percutaneous coronary intervention whereas coronary artery bypass grafting or medical therapy-only was more frequent compared with patients without severe calcification. At 1-year follow-up, MACE occurred in 237 (27.1%) patients with severe calcified coronary lesions and 985 (15%) patients without severe coronary calcified lesions [hazard ratio (HR) 1.91; 95% confidence interval (CI) 1.66-2.20, P < 0.001]. All-cause mortality was 8.6% in patients presenting with and 3.7% in those without severe coronary calcification (HR 2.38, 1.84-3.09, P < 0.001). Patients with severe coronary calcification incurred higher rate of MI (20.1% vs. 11.5%, HR 1.81; 95% CI 1.53-2.1, P < 0.001) and similar rate of stroke (0.8% vs. 0.6%, HR 1.35; 95% CI 0.61-3.02, P = 0.46).
CONCLUSION
Patients with ACS and severe coronary calcification, as compared to those without, are associated with worse clinical outcomes irrespective of the management strategy.
Topics: Humans; Acute Coronary Syndrome; Coronary Artery Bypass; Coronary Artery Disease; Myocardial Infarction; Percutaneous Coronary Intervention; Randomized Controlled Trials as Topic; Risk Factors; Stroke; Treatment Outcome
PubMed: 37812760
DOI: 10.1093/ehjacc/zuad122 -
Cureus Sep 2023Leptomeningeal carcinomatosis (LC) is an uncommon sequelae of metastatic cancer affecting the pia and arachnoid mater. It has been postulated that recent improvements...
Leptomeningeal carcinomatosis (LC) is an uncommon sequelae of metastatic cancer affecting the pia and arachnoid mater. It has been postulated that recent improvements in cancer patient survival time have increased the frequency of LC and other rare metastatic conditions that patients previously would not have lived long enough to experience. LC carries a universally poor prognosis with a mean survival of between two to four months if treated; however, the recent increase in incidence has allowed for further research into the condition and potential treatments. Options for administering chemotherapy have been limited in the past, but recent developments in surgical chemotherapeutic ports have allowed for intrathecal delivery of drugs like methotrexate without systemic exposure. In fact, innovative delivery systems undergoing clinical trials can deliver these drugs in a metronomic fashion to limit the leukoencephalopathy complications of methotrexate. Primary breast cancer is the most common source of metastatic leptomeningeal lesions, and such a lesion was observed by the authors in the cadaver of a 70-year-old Caucasian female with unspecified breast cancer in a medical school anatomic laboratory. The cause of death was listed as "complication of malignant neoplasm of unspecified site of unspecified female breast." Through this case report, we seek to develop our understanding of this rare metastatic phenomenon and highlight the importance of student cadaveric dissection.
PubMed: 37790014
DOI: 10.7759/cureus.44533 -
ACS Applied Electronic Materials Sep 2023Printed circuit boards (PCBs) physically support and connect electronic components to the implementation of complex circuits. The most widespread insulating substrate...
Printed circuit boards (PCBs) physically support and connect electronic components to the implementation of complex circuits. The most widespread insulating substrate that also acts as a mechanical support in PCBs is commercially known as FR4, and it is a glass-fiber-reinforced epoxy resin laminate. FR4 has exceptional dielectric, mechanical, and thermal properties. However, it was designed without considering sustainability and end-of-life aspects, heavily contributing to the accumulation of electronic waste in the environment. Thus, greener alternatives that can be reprocessed, reused, biodegraded, or composted at the end of their function are needed. This work presents the development and characterization of a PCB substrate based on poly(lactic acid) and cotton fabric, a compostable alternative to the conventional FR4. The substrate has been developed by compression molding, a process compatible with the polymer industry. We demonstrate that conductive silver ink can be additively printed on the substrate's surface, as its morphology and wettability are similar to those of FR4. For example, the compostable PCB's water contact angle is 72°, close to FR4's contact angle of 64°. The developed substrate can be thermoformed to curved surfaces at low temperatures while preserving the conductivity of the silver tracks. The green substrate has a dielectric constant comparable to that of the standard FR4, showing a value of 5.6 and 4.6 at 10 and 100 kHz, respectively, which is close to the constant value of 4.6 of FR4. The substrate is suitable for microdrilling, a fundamental process for integrating electronic components to the PCB. We implemented a proof-of-principle circuit to control the blinking of LEDs on top of the PCB, comprising resistors, capacitors, LEDs, and a dual in-line package circuit timer. The developed PCB substrate represents a sustainable alternative to standard FR4 and could contribute to the reduction of the overwhelming load of electronic waste in landfills.
PubMed: 37779887
DOI: 10.1021/acsaelm.3c00799 -
Neuron Dec 2023Leptomeninges, consisting of the pia mater and arachnoid, form a connective tissue investment and barrier enclosure of the brain. The exact nature of leptomeningeal...
Leptomeninges, consisting of the pia mater and arachnoid, form a connective tissue investment and barrier enclosure of the brain. The exact nature of leptomeningeal cells has long been debated. In this study, we identify five molecularly distinct fibroblast-like transcriptomes in cerebral leptomeninges; link them to anatomically distinct cell types of the pia, inner arachnoid, outer arachnoid barrier, and dural border layer; and contrast them to a sixth fibroblast-like transcriptome present in the choroid plexus and median eminence. Newly identified transcriptional markers enabled molecular characterization of cell types responsible for adherence of arachnoid layers to one another and for the arachnoid barrier. These markers also proved useful in identifying the molecular features of leptomeningeal development, injury, and repair that were preserved or changed after traumatic brain injury. Together, the findings highlight the value of identifying fibroblast transcriptional subsets and their cellular locations toward advancing the understanding of leptomeningeal physiology and pathology.
Topics: Mice; Animals; Meninges; Arachnoid; Pia Mater; Choroid Plexus; Brain
PubMed: 37776854
DOI: 10.1016/j.neuron.2023.09.002 -
Cells Sep 2023Immune cells play a critical role in promoting neuroinflammation and the development of neuropathic pain. However, some subsets of immune cells are essential for pain...
Immune cells play a critical role in promoting neuroinflammation and the development of neuropathic pain. However, some subsets of immune cells are essential for pain resolution. Among them are regulatory T cells (Tregs), a specialised subpopulation of T cells that limit excessive immune responses and preserve immune homeostasis. In this study, we utilised intrathecal adoptive transfer of activated Tregs in male and female mice after peripheral nerve injury to investigate Treg migration and whether Treg-mediated suppression of pain behaviours is associated with changes in peripheral immune cell populations in lymphoid and meningeal tissues and spinal microglial and astrocyte reactivity and phenotypes. Treatment with Tregs suppressed mechanical pain hypersensitivity and improved changes in exploratory behaviours after chronic constriction injury (CCI) of the sciatic nerve in both male and female mice. The injected Treg cells were detected in the choroid plexus and the pia mater and in peripheral lymphoid organs in both male and female recipient mice. Nonetheless, Treg treatment resulted in differential changes in meningeal and lymph node immune cell profiles in male and female mice. Moreover, in male mice, adoptive transfer of Tregs ameliorated the CCI-induced increase in microglia reactivity and inflammatory phenotypic shift, increasing M2-like phenotypic markers and attenuating astrocyte reactivity and neurotoxic astrocytes. Contrastingly, in CCI female mice, Treg injection increased astrocyte reactivity and neuroprotective astrocytes. These findings show that the adoptive transfer of Tregs modulates meningeal and peripheral immunity, as well as spinal glial populations, and alleviates neuropathic pain, potentially through different mechanisms in males and females.
Topics: Mice; Male; Female; Animals; T-Lymphocytes, Regulatory; Hyperalgesia; Neuralgia; Spinal Cord; Meninges
PubMed: 37759539
DOI: 10.3390/cells12182317 -
World Neurosurgery Dec 2023Collection of cerebrospinal fluid (CSF) in the subdural compartment is a major cause of postoperative morbidity, especially for posterior fossa surgeries. Arachnoid...
BACKGROUND
Collection of cerebrospinal fluid (CSF) in the subdural compartment is a major cause of postoperative morbidity, especially for posterior fossa surgeries. Arachnoid closure techniques, including suturing of the arachnoid and use of synthetic sealants, have been described in the literature. However, they are not always feasible or effective and have not been universally adopted.
METHODS
We describe the technique of arachnoid welding for a case of brainstem cavernoma. This is a simple, cost-effective, and easily reproducible technique using readily available bipolar cautery kept at a low-current setting. At the end of surgery, the arachnoid leaflets are closely approximated, and bipolar cautery is used to seal the edges together. An illustrative video shows the technical nuances of this procedure. This technique can also be applied for arachnoid closure at other cranial and spinal sites.
RESULTS
Arachnoid closure can act as an effective natural barrier to keep CSF in its physiological subarachnoid compartment. It provides an additional barrier to prevent CSF leak. It also prevents morbidity associated with adhesions and arachnoiditis. Proper closure of arachnoid makes durotomy during repeat surgery much easier and avoids injury to the underlying pia. A brief review of related literature shows the benefits of closing the arachnoid before dural closure and the different techniques that have been described so far.
CONCLUSIONS
The arachnoid welding technique has a wide application, is easy to learn, and can be used especially for posterior fossa surgeries in which rates of CSF leak are the highest.
Topics: Humans; Welding; Postoperative Complications; Cerebrospinal Fluid Leak; Arachnoid; Neurosurgical Procedures; Dura Mater
PubMed: 37739172
DOI: 10.1016/j.wneu.2023.09.047