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Progress in Rehabilitation Medicine 2023Total laryngectomy is a surgical procedure to completely remove the hyoid bone, larynx, and associated muscles as a curative treatment for laryngeal cancer. This leads...
BACKGROUND
Total laryngectomy is a surgical procedure to completely remove the hyoid bone, larynx, and associated muscles as a curative treatment for laryngeal cancer. This leads to insufficient swallowing function with compensative movements of the residual tongue to propel the food bolus to the pharynx and esophagus. However, the neurophysiological mechanisms of compensative swallowing after total laryngectomy remain unclear. Recently, swallowing-related cortical activation such as event-related desynchronization (ERD) during swallowing has been reported in healthy participants and neurological patients with dysphagia. Abnormal ERD elucidates the pathophysiological cortical activities that are related to swallowing. No report has investigated ERD in post-total laryngectomy patients.
CASE
We investigated ERD during volitional swallowing using electroencephalography in three male patients after total laryngectomy for laryngeal cancer (age and time after surgery: Case 1, 75 years, 10 years; Case 2, 85 years, 19 years; Case 3, 73 years, 19 years). In video fluorographic swallowing studies, we observed compensatory tongue movements such as posterior-inferior retraction of the tongue and contact on the posterior pharyngeal wall in all three cases. Significant ERD was localized in the bilateral medial sensorimotor areas and the left lateral parietal area in Case 1, in the bilateral frontal and left temporal areas in Case 2, and in the left prefrontal and premotor areas in Case 3.
DISCUSSION
These results suggest that cortical activities related to swallowing might reflect cortical reorganization for modified swallowing movements of residual tongue muscles to compensate for reduced swallowing pressure in patients after total laryngectomy.
PubMed: 37663527
DOI: 10.2490/prm.20230026 -
Cureus Jul 2023Primary central nervous system lymphomas (PCNLSs) are malignant non-Hodgkin lymphomas solely affecting the central nervous system (CNS). Here, we present a rare case of...
Primary central nervous system lymphomas (PCNLSs) are malignant non-Hodgkin lymphomas solely affecting the central nervous system (CNS). Here, we present a rare case of extra- and intracranial manifestation without adjacent calvarial infiltration. We report a 67-year-old woman who presented with right leg paresis and hypoesthesia, facial hypoesthesia, focal epileptic seizures, and an indolent tumor on the left parietal scalp. MRI showed a left paramedian extra- and intracranial contrast-enhancing tumor with infiltration of the superior sagittal sinus, but without osseous infiltration on CT. The tumor was radiologically suspected to be a meningioma and resection was performed. Histological examination, however, revealed a diffuse large B-cell lymphoma (DLBCL). Thus, the patient received adjuvant treatment according to the MATRix protocol. We provide a detailed analysis of this rare case with a focus on preoperative radiological findings and differential diagnoses. To the best of our knowledge, this is one of only four published cases of DLBCL with extra- and intracranial manifestation without bone affection.
PubMed: 37637562
DOI: 10.7759/cureus.42500 -
Cureus Jul 2023This case report describes an uncommon presentation of lung adenocarcinoma, which appeared as a skull mass. While not the first reported case in medical literature, it...
This case report describes an uncommon presentation of lung adenocarcinoma, which appeared as a skull mass. While not the first reported case in medical literature, it is still a rare occurrence for lung adenocarcinoma to present in this manner. This report focuses on the clinical presentation and treatment of an elderly male patient who had a progressively enlarging and painful skull mass. The initial imaging revealed an about 5 cm soft tissue mass at the dorsal midline of the parietal-occipital bone. Subsequent imaging identified a lung mass, and a biopsy of the skull bone confirmed that the mass was metastatic adenocarcinoma originating from the lung. For treatment, the patient underwent occipital partial resection of the mass, followed by wire mesh cranioplasty. Chemotherapy and external beam radiotherapy were administered to alleviate symptoms and control the spread of cancer. Lung carcinoma with distant metastasis is generally associated with a poorer prognosis. However, some supporting data suggest that early detection and aggressive management play crucial roles in preventing further metastasis and improving the patient's quality of life and overall survival rate. Skull bone metastasis from lung cancer is indeed a rare phenomenon, and cases like these contribute valuable knowledge to the field. By reporting such cases, healthcare professionals can gain a better understanding of the clinical manifestations, diagnostic challenges, and appropriate management strategies for these uncommon occurrences. This case report underscores the significance of maintaining a high index of suspicion and utilizing a multimodality approach to diagnose rare instances of calvarial metastasis.
PubMed: 37621819
DOI: 10.7759/cureus.42399 -
Child's Nervous System : ChNS :... Nov 2023Herein lies a brief historical review of the practice of artificial cranial deformation (ACD) in Tiwanaku, Bolivia, a pre-Columbian archeological ruin once regarded as... (Review)
Review
PURPOSE
Herein lies a brief historical review of the practice of artificial cranial deformation (ACD) in Tiwanaku, Bolivia, a pre-Columbian archeological ruin once regarded as one of the most powerful pre-Inca regions whose influence extended into present-day Peru and Chile from 600 to 1000 AD. We describe the history, purpose, and implications of ACD from both a neuroanatomical and cultural perspective.
METHODS
A literature review was conducted through PubMed on the history of artificial cranial deformation in South America, concentrating on the Tiwanaku region. The authors searched all available data with no specific time reference, using the mentioned keywords: ACD, neuroanatomical implications of ACD, cultural and social functions of ACD, Tiwanaku society, and Andean civilization.
RESULTS
Early Andean civilization was hierarchical and stratified. In Tiwanaku, the practice of ACD served to delineate one's social class, caste, lineage, and vocation. This was especially useful for warriors, who distinguished their fellow combatants from insurgents by differences in their cranial structure. ACD was usually conducted within the first few months of an infant's life before morphogenetic features became permanent. Two popular cranial styles-tabular and annular-were achieved by applying various mechanical apparatus and resulted in several cranial shapes (conical, box-like, flattened, etc.). Neuroanatomically, each deformation technique and the duration for which mechanical stress was applied influenced the solidification of cranial bones and shaped the frontal, occipital, parietal, and temporal bones differently. Cognitive deficits and plagiocephalic defects were recorded in limitation and may have been overlooked as the era's occupational demands were more labor-intensive than knowledge-driven.
CONCLUSION
In Tiwanaku, the custom of ACD was used to demonstrate group identity, with alterations of the cranial shape corresponding to a particular headdress. ACD was used to distinguish an individual's social identity, separating different groups of society into castes, classes, and slaves (Brain, 1979). The custom has also been used to mark territory and emphasize ethnic differences among groups, with potential cognitive implications that were largely unrecorded.
Topics: Infant; Humans; Bolivia; South America; Peru; Archaeology; Temporal Bone
PubMed: 37594563
DOI: 10.1007/s00381-023-06094-w -
Animals : An Open Access Journal From... Jul 2023The present investigation endeavours to discern dental and non-dental pathologies affecting cranial structures of raccoon dogs, while focusing on cases of periodontitis....
The present investigation endeavours to discern dental and non-dental pathologies affecting cranial structures of raccoon dogs, while focusing on cases of periodontitis. Furthermore, the study aims to conduct a comparative analysis based on sex and the nature of the pathologies encountered. The number of investigated skulls amounted to 126, including 76 males and 50 females. The predominant pathology identified was hypodontia, which accounted for 26.7% of males and 20% of females. Notably, the majority of hypodontia cases involved the absence of the mandibular third molar. Another noteworthy pathology was various stages of periodontitis, with rates ranging from 21.3% in males to 8% in females. Other pathologies, like tooth fractures and abrasion, were significantly less encountered. Excessive bone formation was relatively abundant and localized in specific areas-the parietal bone and the occipital regions. This tendency was observed in 8% of male cases and 6% of females. We found that the total number of dental and skull-bone pathologies is significantly more common in males than in females ( = 0.003). Additionally, the total number of various cases of periodontitis is more common in males too ( = 0.04).
PubMed: 37570246
DOI: 10.3390/ani13152437 -
Surgical Neurology International 2023Hepatocellular carcinoma (HCC) is a common malignant tumor with a 5-year survival rate of 10%, presenting with extrahepatic metastases in 15-17% of patients. HCC-bone...
BACKGROUND
Hepatocellular carcinoma (HCC) is a common malignant tumor with a 5-year survival rate of 10%, presenting with extrahepatic metastases in 15-17% of patients. HCC-bone metastases represent approximately one-quarter of all HCC metastases, most frequently in the spine, pelvis, ribs, or femur. HCC-skull metastases, however, make up 0.4-1.6% of all HCC- bone metastases. Furthermore, solitary HCC-skull metastasis without known active primary HCC is an unusual presentation warranting further review and consideration.
CASE DESCRIPTION
Here, the authors report a unique case of a solitary HCC-skull metastasis in a patient without known active cancer but in long-term remission for HCC. The patient is a 69-year-old male with past HCC who presented with a nontender skull mass. A computed tomography scan showed a heterogeneously enhancing mass centered in the high left parietal bone with intracranial extension. There was a noted mass effect on the left posterior frontoparietal region without worrisome midline shift. Pathology ultimately revealed the mass to be metastatic HCC. To aid in the understanding and clinical management of this rare presentation, we reviewed the literature regarding clinical presentation, radiological features, pathology, and outcome.
CONCLUSION
Ultimately, early detection of the primary source of cancer is pivotal to successful treatment and prognosis, and skull lesions such as these must include HCC in the differential diagnosis.
PubMed: 37560598
DOI: 10.25259/SNI_77_2023 -
Cureus Jul 2023Hyperostosis of the skull is a rare bone dysplasia described in disorders such as hyperostosis cranialis interna (HCI) and hyperostosis frontalis interna (HFI). Other...
Hyperostosis of the skull is a rare bone dysplasia described in disorders such as hyperostosis cranialis interna (HCI) and hyperostosis frontalis interna (HFI). Other syndromes presenting with hyperostosis include Morgagni-Stewart-Morel (MSM) and Troell-Junet. HCI is an abnormal hyperostosis of most endosteal skull and calvarium surface regions. A more specific hyperostosis, HFI, is an unusual bone growth based on its volume and porosity; it is primarily located bilaterally on the frontal portions of the calvarium. However, the hyperossification does not cross the superior sagittal sinus. Upon cadaveric dissection, we found hyperossification beyond the frontal area, extending to the parietal and occipital bones with the significant characteristic of no midline interference. Hyperossification results in gross indentations on the corresponding frontal, parietal, and occipital hemispheric brain tissues. This report discusses possible differentials for this rare cadaveric finding of frontal, parietal, and occipital bone hyperostosis. This case report includes some major characteristic features indicative of HCI and HFI with some interesting variations and features suggestive of MSM and Troell-Junet syndromes. Due to the lack of patient history and medical records, no further conclusions about clinical differentials, symptoms, or causative syndromes could be drawn; further research needs to be conducted on HCI, HFI, and related syndromes to understand their presentations better.
PubMed: 37546094
DOI: 10.7759/cureus.41445 -
Child's Nervous System : ChNS :... Nov 2023Langerhans cell histiocytosis (LCH) is a neoplastic transformation of myeloid precursors that commonly presents as an osteolytic lesion of the long or flat bones in... (Review)
Review
BACKGROUND
Langerhans cell histiocytosis (LCH) is a neoplastic transformation of myeloid precursors that commonly presents as an osteolytic lesion of the long or flat bones in children. Aneurysmal bone cysts (ABC) are benign neoplasms that frequently affect the metaphysis of long bones and the spine, often revealing a rapidly expansile lesion with fluid-fluid levels. LCH with secondary ABC-like changes is a rare condition that has only been reported five times, with two presentations in the cranium. The aim of this paper is to review the etiology, clinical and radiographic presentations, and treatment of this condition, as well as to present a novel case on the topic.
CASE DESCRIPTION
We describe a 5-year-old boy with a rapidly growing head mass and eye pain resulting in a diagnosis of LCH with secondary ABC-like changes. Radiography demonstrated an expansile, lytic lesion of the left parietal bone with fluid-fluid levels. A confirmatory diagnosis was made through histopathology, demonstrating an inflammatory, histiocytic infiltrate staining positive for CD1a, CD68, CD207 (Langerin), and S-100. The lesion was surgically excised, and the patient recovered without any complications.
CONCLUSION
We present a novel case of LCH with secondary ABC-like changes managed with surgical excision. While a radiographic workup with multiple imaging modalities is helpful for diagnosis, a thorough immunohistochemical analysis is essential as imaging characteristics are variable and nonspecific. Furthermore, surgical excision should be considered first-line treatment for lesions involving the skull in surgically accessible areas as it is curative, alleviates symptoms, and allows for histopathological diagnosis.
Topics: Child, Preschool; Humans; Male; Bone Cysts, Aneurysmal; Head; Histiocytosis, Langerhans-Cell; Radiography; Skull
PubMed: 37522932
DOI: 10.1007/s00381-023-06108-7 -
Antioxidants (Basel, Switzerland) Jun 2023Glioblastoma (GBM) is an aggressive, common brain cancer known to disrupt redox biology, affecting behavior and DNA integrity. Past research remains inconclusive. To...
Glioblastoma (GBM) is an aggressive, common brain cancer known to disrupt redox biology, affecting behavior and DNA integrity. Past research remains inconclusive. To further understand this, an investigation was conducted on physical training's effects on behavior, redox balance, and genomic stability in GBMA models. Forty-seven male C57BL/6J mice, 60 days old, were divided into GBM and sham groups ( = 15, = 10, respectively), which were further subdivided into trained (Str, Gtr; = 10, = 12) and untrained (Sut, Gut; = 10, = 15) subsets. The trained mice performed moderate aerobic exercises on a treadmill five to six times a week for a month while untrained mice remained in their enclosures. Behavior was evaluated using open-field and rotarod tests. Post training, the mice were euthanized and brain, liver, bone marrow, and blood samples were analyzed for redox and genomic instability markers. The results indicated increased latency values in the trained GBM (Gtr) group, suggesting a beneficial impact of exercise. Elevated reactive oxygen species in the parietal tissue of untrained GBM mice (Gut) were reduced post training. Moreover, Gtr mice exhibited lower tail intensity, indicating less genomic instability. Thus, exercise could serve as a promising supplemental GBM treatment, modulating redox parameters and reducing genomic instability.
PubMed: 37507883
DOI: 10.3390/antiox12071343