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MedRxiv : the Preprint Server For... Nov 2023Pediatric patients with sickle cell disease (SCD) have decreased oxygen-carrying capacity in the blood and reduced or restricted cerebral blood flow resulting in...
Pediatric patients with sickle cell disease (SCD) have decreased oxygen-carrying capacity in the blood and reduced or restricted cerebral blood flow resulting in neurocognitive deficits and cerebral infarcts. The standard treatment for children with SCD is hydroxyurea; however, the treatment-related neurocognitive effects are unclear. A key area of impairment in SCD is working memory, which is implicated in other cognitive and academic skills. N-back tasks are commonly used to investigate neural correlates of working memory. We analyzed functional magnetic resonance imaging (fMRI) of patients with SCD while they performed n-back tasks by assessing the blood-oxygenation level-dependent (BOLD) signals during working memory processing. Twenty hydroxyurea-treated and 11 control pediatric patients with SCD (7-18 years old) performed 0-, 1-, and 2-back tasks at 2 time points, once before hydroxyurea treatment (baseline) and ~1 year after treatment (follow-up). Neurocognitive measures (e.g., verbal comprehension, processing speed, full-scale intelligence quotient, etc.) were assessed at both time points. Although no significant changes in behavior performance of n-back tasks and neurocognitive measures were observed in the treated group, we observed a treatment-by-time interaction in the right cuneus and angular gyrus for the 2- > 0-back contrast. Through searchlight-pattern classifications in the treated and control groups to identify changes in brain activation between time points during the 2-back task, we found more brain areas, especially the posterior region, with changes in the pattern and magnitude of BOLD signals in the control group compared to the treated group. In the control group, increases in 2-back BOLD signals were observed in the right crus I cerebellum, right inferior parietal lobe, right inferior temporal lobe, right angular gyrus, left cuneus and left middle frontal gyrus at 1-year follow-up. Moreover, BOLD signals elevated as the working memory load increased from 0- to 1-back but did not increase further from 1- to 2-back in the right inferior temporal lobe, right angular gyrus, and right superior frontal gyrus. These observations may result from increased cognitive effort during working memory processing with no hydroxyurea treatment. In contrast, we found fewer changes in the pattern and magnitude of BOLD signals across time points in the treated group. Furthermore, BOLD signals in the left crus I cerebellum, right angular gyrus, left cuneus and right superior frontal gyrus of the treated group increased continuously with increasing working memory load from 0- to 2-back, potentially related to a broader dynamic range in response to task difficulty and cognitive effort. Collectively, these findings suggest that hydroxyurea treatment helped maintain working memory function in SCD.
PubMed: 38045394
DOI: 10.1101/2023.11.23.23298960 -
Case Reports in Neurological Medicine 2023A penetrating head injury (PHI) refers to a situation where a projectile has breached the cranium but does not exit it. It constitutes about 0.4% of all head injuries....
BACKGROUND
A penetrating head injury (PHI) refers to a situation where a projectile has breached the cranium but does not exit it. It constitutes about 0.4% of all head injuries. Several nonmissile materials inserting the skull have been reported. But to our knowledge, never before has any case of PHI caused by a hit of rake been reported. We report a first case of PHI caused by a rake in a child; then, we relate our experience with its management and discuss the relevant literature. . A 5-year-old boy has been admitted with a rake embedded in his head. That occurred during a violent play with a neighbor. At presentation, the child was alert; there was no neurological deficit. The rake was embedded in the parietal regions on each side of the midline. The head Computed Tomography (CT) scan performed showed a biparietal hyperdensity from either side of the midline with a metal artifact. In the operating room, after a transversal incision joining the 2 tips of the object, we performed successively bone flaps; object extraction; debridement; duraplasty; and closing. The outcome was uneventful.
CONCLUSION
This is the first case of PHI by a rake. The surgical management constitutes the main challenging point.
PubMed: 38025302
DOI: 10.1155/2023/9921985 -
Cureus Oct 2023Calvarial tuberculosis (TB) is an uncommon form of TB reported in patients with mycobacterial infections. We present a case of calvarial TB in a patient with cervical TB...
Calvarial tuberculosis (TB) is an uncommon form of TB reported in patients with mycobacterial infections. We present a case of calvarial TB in a patient with cervical TB lymphadenitis. The patient had a history of headache and swelling of the right parietal region of the skull. CT head showed peripherally enhancing small epidural collection at the right parietal region with overlying destroyed right parietal bone. Histopathology showed giant cells, lymphocytes, and caseous necrosis. We acknowledge that cervical TB lymphadenitis poses the development of calvarial TB in our patient.
PubMed: 38022152
DOI: 10.7759/cureus.47055 -
Brain Tumor Research and Treatment Oct 2023The authors report an extremely rare case of a massive hyperostotic meningioma en plaque, which had characteristics of unique bony growth. A 34-year-old man presented...
The authors report an extremely rare case of a massive hyperostotic meningioma en plaque, which had characteristics of unique bony growth. A 34-year-old man presented with a palpable solid mass in the left cranial region that had gradually grown in size with a broad base on the calvarium for 8 years. Radiologically, the area involved by the mass ranged from the sphenoid bone to the frontal, parietal, temporal, and occipital bones. Three-dimensional CT revealed multiple growing spiculate features on the inner and outer cranial surface. Even though the radiologic features resembled fibrous dysplasia, it was histologically found to be a type of meningioma.
PubMed: 37953451
DOI: 10.14791/btrt.2023.0027 -
Experimental and Therapeutic Medicine Dec 2023Bony structures around the carotid artery, such as the styloid process and the hyoid bone, can cause dissection, compression, plaque formation and plaque rupture of the...
Bony structures around the carotid artery, such as the styloid process and the hyoid bone, can cause dissection, compression, plaque formation and plaque rupture of the carotid artery. The present study aimed to present a novel case of hyoid bone elongation causing dissecting aneurysm of the carotid artery. However, the patient had no permanent neurologic symptoms. An 80-year-old man presented with right hemiparesis for >5 h despite preventive therapy with antiplatelets and statins. Magnetic resonance imaging revealed acute infarction in the left parietal lobe. Contrast-enhanced computed tomography revealed two cysts with some calcification located at the bifurcation of the right internal carotid artery (ICA) and the right greater horn of the hyoid bone adjacent to the right ICA. A color duplex scan of the carotid vessels confirmed the relationship between dissecting aneurysm and the hyoid bone. In conclusion, greater attention should be paid to the bony structures around the carotid artery.
PubMed: 37928507
DOI: 10.3892/etm.2023.12249 -
Cureus Oct 2023Head trauma in the pediatric population carries a high rate of morbidity and mortality. The major causes of head trauma are related to falls, recreational activities,...
Head trauma in the pediatric population carries a high rate of morbidity and mortality. The major causes of head trauma are related to falls, recreational activities, motor vehicle accidents, and gunshot wounds. Traumatic brain injury (TBI) can occur after severe head trauma and is defined as an alteration in brain function, or other evidence of brain pathology, caused by an external force. Intracranial edema and herniation are common consequences of a TBI in pediatric patients and are commonly relieved via decompressive craniectomy. This case study describes a 13-year-old male presenting to the trauma center after an unhelmeted all-terrain vehicle (ATV) accident with a positive head strike and loss of consciousness. The evaluation revealed extensive skull fractures extending from the frontal to the occipital lobe with brain exposure. Computed tomography (CT) scan of the head demonstrated extensive, open skull fractures with significant displacement of the exposed brain, extensive bilateral parietal and frontal bone fractures, and bilateral temporal bone displaced fractures more extensive on the left. A bilateral hemicraniectomy was performed due to diffuse cerebral edema and a left frontal ventriculostomy was placed to monitor and manage intracranial pressure (ICP). It is believed that the unique presentation of an open skull fracture with an exposed brain acted as a decompressive method allowing for extreme lifesaving measures to be performed to save the patient. Further exploration is needed to truly understand the effects of the unique injury presentation and the role of an open fracture in the delay of increased ICP.
PubMed: 37927750
DOI: 10.7759/cureus.46521 -
Medicina (Kaunas, Lithuania) Sep 2023: Before the introduction of griseofluvin, the use of X-ray radiation was the treatment of choice for tinea capitis. More than half a century later various types of...
Reconstruction of Moderately and Severely Atrophic Scalp-A Multicentric Experience in Surgical Treatment of Patients Irradiated for Tinea Capitis in Childhood and Surgical Algorithm.
: Before the introduction of griseofluvin, the use of X-ray radiation was the treatment of choice for tinea capitis. More than half a century later various types of tumors have been found to be associated with childhood irradiation due to tinea capitis, most commonly cancers of the head and neck, as well as brain tumors. The often unusually aggressive and recurrent nature of these tumors necessitates the need for repeated surgeries, while the atrophic skin with an impaired vascular supply due to radiation often poses an additional challenge for defect reconstruction. We present our experience in the surgical treatment of such patients. : This is a retrospective cohort study. In this study, 37 patients treated for acquired defects of the scalp with a history of irradiation therapy due to tinea capitis in childhood were included in this study, 24 male and 13 female patients. The mean age at the first appointment was 60.6 ± 7.8, with the youngest included patient being 46 and the oldest being 75 years old. Patients' characteristics, surgical treatment, and complications were analyzed and a reconstructive algorithm was developed. : Local flaps were used for reconstruction in 34 patients, direct sutures were used in 10 patients and 20 patients received split-thickness skin grafts for coverage of both primary and secondary defects for reconstruction of flap donor sites. One regional flap and one dermal substitute covered by an autologous skin graft were also used for reconstruction. Complications occurred in 43.2% of patients and were significantly associated with the presence of comorbidities ( = 0.001), aseptic bone necrosis ( = 0.001), as well as skin atrophy in frontal, occipital, and parietal region ( = 0.001, = 0.042 and = 0.001, respectively). A significant correlation between major complications and moderate skin atrophy was found only in the parietal region ( = 0.026). : Unfortunately, many protocols developed for scalp reconstruction are not applicable in the setting of severe or diffuse scalp skin atrophy associated with high tumor recurrence rate and radiation-induced vascular impairment, such as in tinea capitis patients in Serbia. An algorithm has been developed based on the authors' experience in managing these patients.
Topics: Humans; Female; Male; Aged; Scalp; Retrospective Studies; Neoplasm Recurrence, Local; Tinea Capitis; Atrophy; Algorithms
PubMed: 37763798
DOI: 10.3390/medicina59091678 -
Infection and Drug Resistance 2023Highly invasive infections caused by , which includes bacteremia, liver abscess, meningitis, septic arthritis, and osteomyelitis, in not commonly seen in adult...
Highly invasive infections caused by , which includes bacteremia, liver abscess, meningitis, septic arthritis, and osteomyelitis, in not commonly seen in adult immunocompetent and immunocompromised patients. Here, we report an adult case of chronic multifocal osteomyelitis with severe cranial involvement caused by . The patient has a 5-year history of orbital abscess and multiple scalp traumas. CT scan showed right temporal and periorbital osteolysis, multiple parietal osteolysis. The pus was collected twice and routine culture was positive for e. Good clinical outcome was achieved with debridement and antibiotic treatment. Microbiologists and clinicians should promptly perform bacteriological cultures on biopsy specimens to facilitate diagnosis when imaging or intraoperative findings of bone infection are suspected, especially in the Mali population.
PubMed: 37719648
DOI: 10.2147/IDR.S426775 -
Surgical Neurology International 2023Osseous hyperpigmentation of the calvarium is an extremely rare finding with only few reported cases in literature.
BACKGROUND
Osseous hyperpigmentation of the calvarium is an extremely rare finding with only few reported cases in literature.
CASE DESCRIPTION
The case is of a 59-year-old Caucasian male who presented with an acute history of generalized tonic clonic seizures and progressive weakness of the right upper limb. He had a background history of a malignant melanoma which had been resected from his left external acoustic meatus 4 weeks prior. Neuroimaging of the brain showed an intra-axial space-occupying lesion in his left parietal lobe with no associated osseous changes. A left mini parietal craniotomy was performed which revealed black discoloration of the parietal bone. The lesion was successfully resected and the bone flap was secured back in place. The patient was discharged on the 4 day postoperatively with no complications. The unusual finding of black discoloration of the calvarium was found to be secondary to adolescent tetracycline use.
CONCLUSION
Calvarial hyperpigmentation is a phenomenon encountered incidentally and will often come as surprise for surgeons. Once encountered, thorough history taking and examination should be done to investigate the cause.
PubMed: 37680939
DOI: 10.25259/SNI_493_2023