Third Ventricle Research Articles

CEREBRAL MICROVASCULATURE IN AN EXCLUSIVELY FAT DIET MODEL

The microcirculation system plays a major role in the process of food intake and assimilation by the body. It ensures the distribution of oxygen and nutrients among neurons, taking into account their functional activity. The capillaries of the villi in the choroid plexus of cerebral ventricles remain the main source of cerebrospinal fluid production, which determines most physiological functions of the body. The aim of the study is to identify the peculiarities of remodeling of the microvasculature and vascular plexus of the third cerebral ventricle in rats kept exclusively on a fat diet. Materials and Methods. The work was performed on 20 white mongrel male rats (200–250 g.), divided into control and experimental groups. Animals of the control group were on a regular diet. Rats of the experimental group were fed exclusively with fatty food (sheep tail fat). On the 15th and 30th days, the animals were withdrawn from the experiment. A study of biochemical blood parameters (cholesterol, glucose, and protein) was carried out. After decapitation, the brain was fixed in formalin, brain sections were stained with hematoxylin and eosin (Van Gieson stain). The authors conducted light microscopy and morphometry on an Olympus B×40 microscope (Japan). Results. The animals showed a significant increase in the levels of cholesterol, glucose and albumin in the blood serum under an exclusively fat diet. By the 30th day of the experiment, the smooth muscles of the cerebral arteries undergo paresis, proteolysis, vacuolar dystrophy, hypoplasia with a sharp expansion of the vessel lumen. Signs of myoelastofibrosis are observed in the adventitia. Vein walls are thinned, the lumen is dilated, intravascular thrombi are observed. In the choroid plexus of the 3rd cerebral ventricle, a deficit of plasma flow through the sinusoidal capillaries with compensatory ependymocyte hyperfunction is noted. Conclusion. An exclusively fat diet leads to remodeling of the cerebral microvasculature, including the capillaries of the villi of the choroid plexus of the 3rd ventricle. All changes are compensatory and adaptive in nature. However, by the 30th day of the experiment, some of them become irreversible.

POST HERPETIC BASAL GANGLIA STROKE IN AN ADOLESCENT GIRL: BRIEF REVIEW OF LITERATURE AND A CASE REPORT

Herpes simplex encephalitis (HSE) is a leading cause of sporadic, non-epidemic viral encephalitis in children and adults. We report a very rare case of HSE complicated by multiple ischaemic infarcts involving both basal ganglia in a 15-year-old female adolescent admitted with complaints of headache and fever, irrational behavior and seizures. On clinical examination patient was unconscious with signs of raised intracranial pressure, right hemiparesis and meningeal irritation. She had elevated temperature (38.7°C), and anaemia (packed cell volume of 25.0%). Magnetic resonance imaging showed features of Multiple non-enhancing hypodensities in both basal ganglia with mild dilation of the 3rd and lateral ventricles. She was managed as a case of Post-encephalitis Basal ganglia stroke. The patient subsequently developed a repeat vascular event, with suspected haemorrhagic transformation after 4 weeks and succumbed to the illness.

The hypervirulent Group B Streptococcus HvgA adhesin promotes central nervous system invasion through transcellular crossing of the choroid plexus

BackgroundGroup B Streptococcus (GBS) is the leading cause of neonatal meningitis responsible for a substantial cause of death and disability worldwide. The vast majority of GBS neonatal meningitis cases are due to the CC17 hypervirulent clone. However, the cellular and molecular pathways involved in brain invasion by GBS CC17 isolates remain largely elusive. Here, we studied the specific interaction of the CC17 clone with the choroid plexus, the main component of the blood-cerebrospinal fluid (CSF) barrier.MethodsThe interaction of GBS CC17 or non-CC17 strains with choroid plexus cells was studied using an in vivo mouse model of meningitis and in vitro models of primary and transformed rodent choroid plexus epithelial cells (CPEC and Z310). In vivo interaction of GBS with the choroid plexus was assessed by microscopy. Bacterial invasion and cell barrier penetration were examined in vitro, as well as chemokines and cytokines in response to infection.ResultsGBS CC17 was found associated with the choroid plexus of the lateral, 3rd and 4th ventricles. Infection of choroid plexus epithelial cells revealed an efficient internalization of the bacteria into the cells with GBS CC17 displaying a greater ability to invade these cells than a non-CC17 strain. Internalization of the GBS CC17 strain involved the CC17-specific HvgA adhesin and occurred via a clathrin-dependent mechanism leading to transcellular transcytosis across the choroid plexus epithelial monolayer. CPEC infection resulted in the secretion of several chemokines, including CCL2, CCL3, CCL20, CX3CL1, and the matrix metalloproteinase MMP3, as well as immune cell infiltration.ConclusionOur findings reveal a GBS strain-specific ability to infect the blood-CSF barrier, which appears to be an important site of bacterial entry and an active site of immune cell trafficking in response to infection.

Morphometric MRI Study of Third Ventricle of Brain among Bangladeshi Adults

Background: The third ventricle of the brain is a small median cleft located in the diencephalon between right and left thalamus; anteriorly it communicates to the lateral ventricles by foramen of Monro, posteriorly connects to the fourth ventricle through the cerebral aqueduct. Morphometry and accurate measurements of the brain ventricles have clinical importance because various diseases affect the size and morphology of the ventricles. Objective: This study was aimed to determine the morphometry of third ventricle of brain by magnetic resonance imaging (MRI) scan. Methods: This cross-sectional study was conducted at Department of Anatomy, Dhaka Medical College, Dhaka, Bangladesh from January 2020 to December 2020. Patients referred by Department of Medicine, Dhaka Medical College Hospital (DMCH) for MRI were enrolled as study subjects. Total 100 adult Bangladeshi subjects (50 male and 50 female) were selected following selection criteria. Their MRI of brain was done by MAGNETOM VIDA (3T Tesla) SIEMENS MRI machine following standard procedure. The MRI scans were evaluated by registered radiologists. All parameters were measured from the soft copy of MRI scans using RadiAnt DICOM Viewer. Results: The mean (±SD) maximum height of the third ventricle was 23.69 ± 1.13 mm in male and 22.38 ± 0.72 mm in female, that was significantly larger in male (p<0.001). The mean (±SD) anterior-posterior length of third ventricle was 27.17 ± 0.67 mm and 26.16 ± 0.58 mm in male and female respectively, which was significantly higher in male than female (p<0.001). However, no significant difference was observed in mean (±SD) anterior-posterior commissural distance between male and female (26.47 ± 1.6 mm and 26.06 ± 1.00 mm, p= 0.129). The mean (±SD) maximum width of third ventricle was found significantly higher in male than female (4.33 ± 0.41 mm versus 3.68 ± 0.68 mm, p<0.001). Conclusion: The maximum height, anterior to posterior length and maximum width of third ventricle ........

LGG-58. A MULTI-CENTER RETROSPECTIVE CASE SERIES OF SURGICAL OUTCOMES FOR INTRAVENTRICULAR JUVENILE PILOCYTIC ASTROCYTOMA

Abstract INTRODUCTION Juvenile pilocytic astrocytoma (JPA) is a common pediatric grade I astrocytoma. Prognosis is excellent with gross total resection (GTR) and 10-year survival rates of up to 95%. However, undesirable outcomes may occur, such as when tumors are in poorly accessible locations. Intraventricularly tumors present a unique surgical challenge due to their midline location in a fluid filled space with any intraparenchymal invasion involving critical neurologic structures. Here we retrospectively describe the clinical features of intraventricular JPA neoplasms from two centers to highlight the challenges in caring for this uncommon presentation. METHODS We retrospectively searched the electronic medical record from 2000-2023 for patients with neurosurgical treatment for intraventricular JPA at two centers. Intraventricular location was verified by a neuroradiologist. Data were collected on demographics, pathology, tumor location, extent of resection, adjuvant therapies, reoccurrence, progression, and neurological deficit. RESULTS We identified 28 surgical treated patients with intraventricular JPA. Females were 15/28 (54%) of patients with a mean age of 11.2±6.4 years. Most tumors presented in the 4th ventricle 15/28 (53.5%), followed by 9/28 (32%) in 3rd ventricle locations, and 4/28 (14%) in lateral ventricles. GTR was achieved in 12/28 patients (43%) and STR in 16/28 patients (57%). Progression/recurrence was noted in 8/28 (29%) and the 5-year PFS was 56% (10/18). Adjuvant treatment was used in 11/28 (39%) patients and repeat surgery was required in 4/28 patients (14%). Chemotherapy in 8/28 (29%) patients and radiation in 4/28 (14%) patients. A pre/post-operative neurological deficit was noted in 10/28 (36%) patients. A BRAF protein fusion was noted in 7 patients and 1 patient demonstrated a v600E mutation (some molecular data not available). Average follow up was 92 months with no deaths. CONCLUSION We observed that intraventricular JPA tumors commonly undergo subtotal resection with frequent progression/recurrence. Subsequently, recurrent surgeries and adjuvant therapies can be necessary.

An 11-month-old boy with tuberculous meningitis presenting as progressive limb weakness, fever, developmental retardation, and loss of consciousness: a case report

BackgroundTuberculous meningitis (TBM) accounts for about 1% of all tuberculosis cases and about 5% of extrapulmonary tuberculosis cases. However, it poses major importance because approximately half of those affected die or become severely disabled. Herein, the successful treatment of an 11-month-old boy with progressive limb weakness, fever, developmental retardation, and loss of consciousness due to tuberculosis, was reported.Case presentationAn 11-month-old (Iranian Turk) boy was referred to Loghman Hakim hospital for progressive limb weakness and loss of previously attained developmental milestones for the past 2 months. He also had persistent fever and loss of consciousness for about 14 to 21 days. Before being referred to our center, the patient had been diagnosed with hydrocephalus at another center due to possible acute bacterial meningitis based on a CT scan and MRI imaging. On physical examination, anterior fontanel bulging and neck stiffness were observed on the admission. His body temperature and heart rate were 38.1 C and 86 beats per minute (bpm), respectively. He had left 6 cranial nerve palsy and spastic quadriparesis with a power of grade 3/5. Other systemic examinations were normal. Endoscopic third ventriculostomy (ETV) (and leptomeningeal biopsy) revealed diffuse thickening of the floor and lateral walls of the 3rd ventricle and also a cobblestone appearance in the form of multiple white patchy lesions was detected on the floor of the 3rd ventricle. CSF analysis and polymerase chain reaction confirmed the TB meningitis. During hospitalization, a temporary EVD (external ventricular drain) was initially inserted. Eventually, defervescence was denoted 5–6 days after initiation of anti-TB medications, and a permanent ventriculoperitoneal shunt was inserted due to hydrocephalus. Gradually his truncal and limb tone and motor function improved, as did his emotional responses to his parents and ability to eat. The patient can walk without help in the 15th month following the operation and resolved hydrocephalus demonstrated on follow-up imaging.ConclusionOver half of treated TB meningitis patients die or suffer severe neurological sequelae, mainly due to late diagnosis. Hence, early diagnosis and prompt initiation of TB treatment offer the best chance of a good neurological outcome.

869 Early Signs of Elevated Intracranial Pressure (ICP) on Computed Tomography Correlate With Measured ICP in the Intensive Care Unit and Six-month Outcome Following Moderate to Severe TBI

INTRODUCTION: Identifying patients at risk for increased intracranial pressure (ICP) followingTBI via baseline computed tomography (CT) has not previously been validated in a prospective dataset. METHODS: Data were obtained from the Progesterone for Traumatic Brain Injury, Experimental Clinical Treatment (ProTECTIII) multicenter clinical trial. Baseline CT scans for 881 participants were individually reviewed by a blinded central neuroradiologist. Five signs of elevated ICP were measured (sulcal obliteration, lateral ventricle compression, 3rd ventricle compression, midline shift, and herniation). Associations between signs of increased ICP and outcomes (6-month functional outcome and mortality) were assessed. RESULTS: Sulcal obliteration (p = 0.029) and third ventricular compression (p = 0.039) were associated with elevated ICP. Univariate regression analyses indicated that increasing combinations of the five defined signs of elevated ICP were associated with mortality, poor functional outcome, and time to death. There was also an increased likelihood of mortality if patients required craniotomy (OR = 4.318, 95% Confidence Interval [1.330-16.030]) or hemicraniectomy (OR = 2.993 [1.109-8.482]). On multivariate regression analyses, hemorrhage location was associated with mortality (posterior fossa, OR = 3.208 [1.120-9.188] and basal ganglia, OR = 3.079 [1.178-8.077]). Volume of hemorrhage >30cc was also associated with increased mortality, OR = 3.702 [1.575-8.956]). The proportion of patient hours with sustained ICP = 20 mmHg, and maximum ICP = 20 mmHg, were also directly correlated with increased mortality (OR = 64.99 [7.731-635.51]; and OR = 1.025 [1.004-1.047]). Poor functional outcome was predicted by concurrent presence of all five radiographic signs of elevated ICP (OR = 4.44 [1.514-14.183]) and presence of frontal lobe (OR = 2.951 [1.265-7.067]), subarachnoid (OR = 2.231 [1.067-4.717]), or intraventricular (OR = 2.249 [1.159-4.508]) hemorrhage. Time to death was modulated by total patient days of elevated ICP = 20 mmHg (Effect Size = 3.424 [1.500, 5.439]) in the first two weeks of hospitalization. CONCLUSIONS: ICP-related imaging variables can be prognosticate for moderate-severe TBI.

A rare cause of dizziness: Hakim-Adams syndrome

It was first reported in 1965 by Hakim, Adams et al. the term normal pressure hydrocephalus (NPH) was defined by. Because of this definition, it was recorded in the literature as Hakim-Adams syndrome. A 32-year-old male patient was admitted to the green area of our emergency department with a complaint of dizziness. In the physical examination of the patient, no pathological findings were found other than mild ataxia. The brain computed tomography (CT) report revealed that the 3rd ventricle and lateral ventricles were dilated and there was a space-occupying lesion at the 4th ventricle level. The earliest sign of normal pressure hydrocephalus (NPH) is no impairment in walking. It usually manifests itself in older ages. Thanks to the anamnesis and physical examination taken in the emergency departmant and the skeptical approach, further examination was requested for the patient.

Correlation between Transcranial Ultrasound and CT Head to Detect Clinically Significant Conditions in Post-craniectomy Patients Performed by Emergency Physician: A Pilot Study.

The main objective is to detect clinically significant conditions by transcranial ultrasound (TCS) in post-decompressive craniectomy (DC) patients who come to the emergency department. This was a cross-sectional observational study. We studied 40 post-DC patients. After primary stabilization, TCS was done. Computer tomography of head was done within 2 hours of performing TCS. The correlation between both modalities were assessed by the measurement of lateral ventricle (LV) (Bland-Altman plot), Midline shift and mass lesion. Additionally, normal cerebral anatomy, 3rd and 4th ventricles and external ventricular drainage (EVD) catheter visualization were also done. About 14/40 patients came with non-neurosurgical complaints and 26/40 patients came with neurosurgical complaints. Patients with non-neurosurgical complaints (4/14) had mass lesions and 1/14 had MLS. Patients with neurosurgical complaints (11/26) had mass lesions and about 5 patients had MLS. A good correlation was found between TCS and CT of head in measuring LV right (CT head = 17.4 ± 13.8 mm and TCS = 17.1 ± 14.8 mm. The mean difference (95% CI) = [0.28 (-1.9 to 1.33), ICC 0.93 (0.88-0.96)], Left [CT head = 17.8 ± 14.4 mm and TCS = 17.1 ± 14.2 mm, the mean difference (95% CI) 0.63 (-1.8 to 0.61), ICC 0.96 (0.93-0.98)], MLS [CT head = 6.16 ± 3.59 (n = 7) and TCS = 7.883 ± 4.17 (n = 6)] and mass lesions (kappa 0.84 [0.72-0.89] [95% CI] p-value < 0.001). The agreement between both modalities for detecting mass lesions is 93.75%. Point of care ultrasound (POCUS) is a bedside, easily operable, non-radiation hazard and dynamic imaging tool that can be used for TCS as a supplement to CT head in post-DC patients in emergency as well as in ICU. However, assessment of the ventricular system (pre/post-EVD insertion), monitoring of regression/progression of mass lesion, etc. can be done with TCS. Repeated scans are possible in less time which can decrease the frequency of CT head. Chouhan R, Sinha TP, Bhoi S, Kumar A, Agrawal D, Nayer J, et al. Correlation between Transcranial Ultrasound and CT Head to Detect Clinically Significant Conditions in Post-craniectomy Patients Performed by Emergency Physician: A Pilot Study. Indian J Crit Care Med 2024;28(3):299-306.

Hypothalamic tanycytes as mediators of maternally programmed seasonal plasticity

In mammals, maternal photoperiodic programming (MPP) provides a means whereby juvenile development can be matched to forthcoming seasonal environmental conditions.1,2,3,4 This phenomenon is driven by in utero effects of maternal melatonin5,6,7 on the production of thyrotropin (TSH) in the fetal pars tuberalis (PT) and consequent TSH receptor-mediated effects on tanycytes lining the 3rd ventricle of the mediobasal hypothalamus (MBH).8,9,10 Here we use LASER capture microdissection and transcriptomic profiling to show that TSH-dependent MPP controls the attributes of the ependymal region of the MBH in juvenile animals. In Siberian hamster pups gestated and raised on a long photoperiod (LP) and thereby committed to a fast trajectory for growth and reproductive maturation, the ependymal region is enriched for tanycytes bearing sensory cilia and receptors implicated in metabolic sensing. Contrastingly, in pups gestated and raised on short photoperiod (SP) and therefore following an over-wintering developmental trajectory with delayed sexual maturation, the ependymal region has fewer sensory tanycytes. Post-weaning transfer of SP-gestated pups to an intermediate photoperiod (IP), which accelerates reproductive maturation, results in a pronounced shift toward a ciliated tanycytic profile and formation of tanycytic processes. We suggest that tanycytic plasticity constitutes a mechanism to tailor metabolic development for extended survival in variable overwintering environments.

Effects of glucagon as a neurohormone on the central nervous system and glucose homeostasis.

This study aimed to elucidate the possible effects of the acute/long-term infusion of glucagon in the brain as the regulatory role on the endocrine secretions of the pancreas. Ninety male Wistar albino rats were divided as Control, artificial Cerebrospinal Fluid (aCSF) (120 min), Glucagon (120 min), pancreatic denervation (PD)+aCSF (120 min), PD+Glucagon (120 min), aCSF (7 days), Glucagon (7 days), PD+aCSF (7 days) and PD+Glucagon (7 days). Glucagon and solvent (aCSF) were administered after pancreatic denervation (PD) by Hamilton syringe and osmotic mini pump (1 µg/10 µl/min) in the third ventricle of the brain. Acute intracerebroventricular (icv) administration of glucagon resulted in an elevation of glucagon levels and a concurrent reduction in blood glucose levels. Furthermore, in both the PD+aCSF (7 days) and PD+Glucagon (7 days) groups, there was a notable decrease in propiomelanocortin (POMC) and agouti-related protein (AgRP). Significant changes were observed in feed consumption and body weight, as well as pancreatic glucagon levels, with a simultaneous decrease in insulin levels in the PD (7 days), Glucagon (7 days), and PD+Glucagon (7 days) groups. These alterations were statistically significant when compared to the control group (p<0.05). The research outcomes established that pancreas-secreted glucagon functions as a neurohormone within the brain, activating central pathways linked to blood glucose regulation. The presence of glucagon led to a decrease in POMC levels. Surprisingly, this reduction in POMC resulted in the suppression of AgRP. Contrary to expectations, the suppression of AgRP led to an increase in food intake rather than a decrease. As already highlighted in the results section, it was emphasized that POMC may play a more significant role than AgRP in influencing feeding behavior.

Cognitively healthy Indians with higher Framingham Cardiovascular Risk Scores have higher WMH burden with lesser grey matter, white matter and hippocampal volumes

AbstractBackgroundIncreasing evidence indicates the important role of cardiovascular risk factors in dementia risk, particularly in Indians. It is known that cardiovascular risk factors tend to cluster together, and a widely used multivariable risk scoring is the Framingham Cardiovascular Risk Score (FRS). However, very little is known about the association between FRS and structural brain MRI parameters in cognitively healthy Indians.MethodBaseline clinical and brain MRI data of 487 cognitively healthy Indians (Clinical Dementia Rating score of ‘0’), who are part of two ongoing, large, aging cohort studies in India – Srinivaspura Aging, Neuro Senescence and COGnition study (SANSCOG) study (n = 200) and Tata Longitudinal Study of Aging (TLSA, n = 289) were utilized. FRS was calculated using clinical and blood biochemistry data, whereas brain MRI scans were performed on 3T MRI scanners. White matter hyperintensity (WMH) lesion segmentation was performed using Lesion Segmentation Toolbox (LST) and brain volumes (total grey matter, total white matter, 3rd ventricle, right and left hippocampus) were derived using FreeSurfer software and normalized according to total intracranial volumes of the respective subjects. Linear regression analysis was performed with FRS as independent variable and various structural MRI parameters as dependent variables. A p value of &lt;0.05 was considered significant.ResultUrban subjects with higher FRS had significantly higher WMH volume (β = 0.00011, p&lt;0.001, R2 = 0.130), lower grey matter (β = ‐0.00285, p&lt;0.001, R2 = 0.206), white matter (β = ‐0.00180, p&lt;0.001, R2 = 0.106), right hippocampal (β = ‐0.00004, p&lt;0.001, R2 = 0.180), left hippocampal (β = ‐0.00003, p&lt;0.001, R2 = 0.156) volumes and higher 3rd ventricle volumes (β = 0.00003, p&lt;0.001, R2 = 0.150). Rural subjects higher FRS had lower grey matter (β = ‐0.00166, p&lt;0.001, R2 = 0.118, white matter (β = ‐0.0011, p&lt;0.001, R2 = 0.060), right hippocampal (β = ‐0.00002, p&lt;0.001, R2 = 0.087), left hippocampal (β = ‐0.00002, p&lt;0.001, R2 = 0.084) volumes and higher 3rd ventricle volumes (β = 0.00004, p&lt;0.001, R2 = 0.264) but no significant association was seen with WMH volume.ConclusionThese findings indicate that cardiovascular risk is associated with structural brain changes in cognitively healthy Indians. Since cardiovascular risk can be reduced through cost‐effective community level strategies, such as lifestyle‐based interventions, promptly addressing this risk in Indians could be an important part of dementia prevention strategies.

Atypical Teratoid Rhabdoid Tumor: 28-years institutional experience

Abstract Introduction/Objective Atypical teratoid/rhabdoid tumor (ATRT) is a malignant central nervous system tumor affecting young children, characterized by biallelic mutations of SMARCB1 (hSNF5/INI1), consisting of a varying mixture of rhabdoid cells, small round blue cell (SRBC) and epithelial/mesenchymal components. Combination of surgical resection, chemoradiotherapy and autologous stem cell transplantation (SCT) has led to significant improvement in survival. Methods/Case Report Cases of ATRT in the past 28 years have been re-examined, including H&amp;E stains, immunohistochemistry, available molecular studies and clinical charts. Results (if a Case Study enter NA) A total of 23 cases of ATRT were recruited to include 20 pediatric (age 3-36 months, median 13.5 months) and 3 adult cases (27, 38 and 46 years). 73.9% were male. Two pediatric cases presented in patients with Pierre-Robin sequence and Phelan-McDermid syndrome and one adult had history of Choriocarcinoma. 72.7% of cases initially presented in the posterior fossa, with 3 cases presenting in temporal lobe, 1 in frontal lobe, 1 in 3rd ventricle and 1 in pituitary gland. Mean size at presentation was 4.7 cm (range 2-10 cm). Median survival was 12.5 weeks with 8 patients surviving 5-13 years. 10/22 cases developed recurrences and/or spinal drop metastasis. Median time to first recurrence/ drop metastasis was 3.5 months (range 0-66 months). Cases showed varying proportions of rhabdoid, SRBC, epithelioid and mesenchymal components. By immunohistochemistry, INI1 was lost in 19/19 cases. Keratins, GFAP and Synaptophysin were positive in 13/17, 14/20 and 17/21 cases, respectively. Interestingly, GAB-1 and YAP1 were positive in 5/6 and 4/4 cases, respectively. Five cases had SMARCB1 mutation on NGS, one had NF2 truncation and another showed variation of unknown significance involving mainly NOTCH1 gene. 21/22 patients underwent surgical resection, of which 17 additionally received a combination of chemoradiotherapy and SCT and 1/22 underwent palliation. Conclusion Our data highlights the spectrum of presentation and survival of cases of ATRT and the importance of INI1 immunohistochemistry in the diagnosis, especially for the occasional cases co-expressing GAB1 and YAP, a potential diagnostic pitfall with medulloblastoma.

Abstract 14002: Endovascular Embolization and Coiling for an Intracranial Aneurysm in a 9 - Month Old Infant With Kawasaki Disease- A Unique Case Report

Introduction: Cerebrovascular involvement is rare in Kawasaki disease.We present a unique case of such an infant who developed intraventricular haemorrhage and was diagnosed with an intracranial aneurysm. Case Report: A 9-month-old female infant was referred to us with 5 days of high-grade intermittent fever &amp; watery diarrhoea that did not respond to routine care. On arrival, she was stable with WBC count 20,000/UL, CRP 111 mg/L &amp; ESR 85 mm/hr.She continued to have fever spikes and Echocardiography revealed dilated left coronaries with a LAD Z score of +2.92. Hence, by pediatric guidelines, she was started on IVIg (2g/kg) for Kawasaki disease. Repeat echocardiography 2 days later showed reduction in coronary prominence. On Day 10, the child developed episodes of abnormal posturing and respiratory failure. MRI brain showed intraventricular haemorrhage in dependent horns of bilateral lateral, 3rd and 4th ventricles and subarachnoid haemorrhage. CT angiography showed a saccular aneurysm at the junction of V4 segment of right vertebral artery &amp; basilar artery (Figure 1). She underwent endovascular embolization, coiling of aneurysm&amp; omaya reservoir insertion(Figure 2). She was weaned off supportive care &amp; recovered well. Conclusion: Unlike fe existing reports, haemorrhage occurred during active phase of the disease and not years after diagnosis. To our knowledge, this is the first report of endovascular management of aneurysmal subarachnoid haemorrhage in KD in an infant. This uncommon presentation in an infant warrants discussion on whether routine screening of all children suspected of Kawasaki disease for extracardiac aneurysms might be potentially life-saving.

Surgical aspects of classification and neuroimaging characteristics of idiopathic hydrocephalus in adults

Background. Hydrocephalus can be developing by a traumatic brain injury, intracranial hemorrhage, tumor, meningitis of congenital malformation of the central nervous system. When the cause of the hydrocephalus is unclear it is supposed as idiopathic hydrocephalus. The most important classification features are the etiology and level of CSF obstruction. The classification was improved and developed with diagnostic and surgical methods simultaneously. Currently, the neurosurgeons have the possibility for usage of various methods and techniques of surgical treatment with their advantages and disadvantages. Systematization of radiological parameters is necessary to make a decision about the type of the surgery.Aim. To analyze and systematize the neuroimaging characteristics of various forms of idiopathic hydrocephalus in adults, to assess the possible classification of idiopathic hydrocephalus.Materials and methods. Between October 2011 and March 2021 290 patients with idiopathic adult hydrocephalus were operated at the N.N. Burdenko National Medical Research Center of Neurosurgery of the Ministry of Health of Russia: onset of symptoms in adulthood; no indications of the etiology of hydrocephalus and congenital hydrocephalus. The age of the patients was 50 ± 18.2 (18–85) years. The magnetic resonance images of patients were evaluated for the size of the ventricles, condition of convexital and basal subarachnoid spaces, obstruction of the CSF pathways, and changes in the position of the premamillary membrane, septum pellucidum, the roof of the 3rd ventricle and the tonsils of the cerebellum, the size of the sella turcica, the angle of the corpus callosum. The frequency of each of these parameters is statistically estimated for each form of idiopathic hydrocephalus.Results. Aqueduct stenosis has become the most frequent form of idiopathic hydrocephalus. Hydrocephalus in obstruction of the foramen of Monroe, aqueduct, foramen of Magendie, and cisterns of the posterior cranial fossa was significantly more characteristic of young people (p &lt;0.05). Hydrocephalus with obstruction of convexital CSF spaces can be called hydrocephalus of the elderly (p &lt;0.001). Hydrocephalus without verified signs of occlusion CSF pathways occurs equally in all age groups. The FOHR index was significantly more important, and only in case of cisternal obstruction. Enlargement one or both lateral ventricles and flattening of the roof of the 3rd ventricle is characterized for Monro’s foramen obstruction (p &lt;0.001). The membrane at the outlet of the 4th ventricle and the absence of the “flow void” was typically only for patients with obstruction of the foramen of Magendie (p &lt;0.001). Ventral dislocation of the premamillary membrane was characteristic of obstruction of the cerebral aqueduct, the foramen of Magendie, and cisterns of the posterior cranial fossa. Compression of the convexital CSF spaces occurred in case of obstruction of the aqueduct, the foramen of Magendie, but CSF spaces of the posterior cranial fossa – only with obstruction of the foramen of Magendie. Dilation of the 4th ventricle was significantly associated with obstruction of the foramen of Magendie and cisterns of the posterior cranial fossa (p &lt;0.05). DESH symptom was significantly associated with obstruction of convexital CSF spaces (p &lt;0.001). Additional membranes in the cisterns of the posterior fossa were found only in cases of cisternal obstruction (p &lt;0.001). Cerebellar tonsils herniation was observed with obstruction of the foramen of Monroe, cerebral aqueduct, and foramina of Magendie.Conclusion. Because of statistical analysis, general signs found in all types of hydrocephalus, and private ones, characterizing only specific signs of the type of the disease, both were found. The classification is logical and justified, it is well applicable in neurosurgical and radiological practice. It allows rational planning of diagnostic evaluation and treatment of patients. A modern magnetic resonance imaging protocol should include T2 scans (with “flow void”) and FIESTA/CISS scans in the required planes, axial FLAIR scans.

FRI278 Kisspeptin Neuron Projections And Expression Patterns Are Unaltered In Prenatally Androgenized Female Mice Modeling PCOS

Abstract Disclosure: M. Prescott: None. Y. Watanabe: None. A. Ruddenklau: None. L. Fisher: None. C.L. Jasoni: None. R.E. Campbell: Consulting Fee; Self; Bayer, Inc. Polycystic ovary syndrome (PCOS) is associated with impaired gonadal steroid hormone feedback and a hyperactive central reproductive axis, implicating the brain in PCOS pathophysiology. Excess prenatal androgen (PNA) exposure is linked with the development of PCOS, and preclinical evidence suggests that PNA can program altered connections within the gonadotropin-releasing hormone (GnRH) neuronal network. Kisspeptin neurons are critical upstream regulators of GnRH neurons, relaying hormone feedback and potently activating GnRH secretion, but their role in PCOS remains incompletely understood. This study tested the hypothesis that prenatal androgen excess programmes altered neuroanatomical connections between kisspeptin neurons and GnRH neurons and modified neuropeptide and steroid hormone receptor expression in kisspeptin neurons. To investigate this, we labelled, imaged and assessed kisspeptin fibers, GnRH neurons, and gonadal steroid hormone receptors in adult female transgenic kisspeptin reporter mice (Kiss1(Cre-GFP)Coll; ROSA26tdTomato) exposed prenatally to di-hydrotestosterone or an oil vehicle (VEH) on gestational days 16-18 (n=7-10/group). PNA mice were acyclic and all tissue was collected in diestrus. Fixed coronal brain sections were immunofluorescently labelled for GnRH and kisspeptin reporter tdTomato and imaged on a confocal microscope to assess close fiber contacts to the soma and proximal dendrite of GnRH neurons. Neither the proportion of GnRH neurons with kisspeptin fiber contacts (VEH: 86.3±3.4%, PNA: 87.3±4.3%), nor the mean number of kisspeptin fiber close appositions per GnRH neuron (VEH: 6.1±0.6, PNA: 5.7±0.8) was different between groups. Kisspeptin neuron number and kisspeptin neuron co-expression with estrogen and progesterone receptors was evaluated in immunolabelled sections throughout the rostral periventricular nucleus of the 3rd ventricle (RP3V) and the arcuate nucleus (ARN). PNA had no significant impact on kisspeptin neuron number or the proportion of neurons with gonadal hormone co-expression in either population. Expression of neuropeptides was quantified by RT-qPCR in micro-dissected RP3V and ARN tissue from a separate cohort of adult PNA and VEH mice (n=5-8/group). PNA did not affect Kiss1, Tac2 or Pdyn expression in the ARN or Kiss1 expression in the RP3V. These data indicate that PNA does not modify anatomical connections between RP3V kisspeptin neurons and GnRH neurons, nor does it have a robust impact on steroid hormone responsiveness or neuropeptide expression of kisspeptin neurons. While the neuroanatomical relationship between ARN kisspeptin neurons and the GnRH neuron distal dendron in PNA mice remains to be determined, these data suggest that PNA-mediated neuroendocrine dysfunction is not due to programmed changes in the neuroanatomical projections or gonadal hormone sensitivity of kisspeptin neurons. Presentation: Friday, June 16, 2023

Development of the prosencephalic structures, ganglionic eminence, basal ganglia and thalamus at 11 + 3 to 13 + 6 gestational weeks on 3D transvaginal ultrasound including normative data

ObjectivesTo show the development of ganglionic eminence, basal ganglia and thalamus/hypothalamus in week 11 + 3 to 13 + 6 by transvaginal 3D ultrasound.MethodsTo visualize the prosencephalic structures surrounding the 3rd ventricle, 285 three-dimensional ultrasound volume blocks from 402 fetuses examined were selected in a prospective transvaginal 3D study to compare ultrasound images of ganglionic eminence, basal ganglia, thalamus/hypothalamus with embryological sections. In addition, measurements of the described structures were made in 104 fetuses to quantify the embryological development.ResultsThe sonomorphologic characteristics of ganglionic eminence, basal ganglia and thalamus/hypothalamus are described in 71% of the fetuses examined. Measurements of the structures in 57% of the fetuses, show the following results: axGE ap = 0.17 + 0.112*CRL; axGE/I = 0.888 + 0.048*CRL; axGE/BG = 0.569 + 0.041*CRL; coGE/BG = 0.381 + 0.048*CRL; coTh lat = − 0.002 + 0.135*CRL; coTh/HyT = 3.68 + 0.059*CRL; co3.V lat = 0.54 + 0.008*CRL.ConclusionTransvaginal 3D neurosonography allows visualization and measurement of normal structures in the fetal prosencephalon at 11 + 3 to 13 + 6 weeks of gestation (GW) including details of ganglionic eminence (GE), basal ganglia (BG), and thalamus/hypothalamus (Th/HyT). Further scientific work is needed before using the results to decide on pathological changes in patients.

Control by the brain of vitamin A homeostasis

Vitamin A is a micronutrient essential for vertebrate animals maintained in homeostatic balance in the body; however, little is known about the control of this balance. This study investigated whether the hypothalamus, a key integrative brain region, regulates vitamin A levels in the liver and circulation. Vitamin A in the form of retinol or retinoic acid was stereotactically injected into the 3rd ventricle of the rat brain. Alternatively, retinoids in the mouse hypothalamus were altered through retinol-binding protein 4 (Rbp4) gene knockdown. This led to rapid change in the liver proteins controlling vitamin A homeostasis as well as vitamin A itself in liver and the circulation. Prolonged disruption of Rbp4 in the region of the arcuate nucleus of the mouse hypothalamus altered retinol levels in the liver. This supports the concept that the brain may sense retinoids and influence whole-body vitamin A homeostasis with a possible "vitaminostatic" role.

Neural Progenitor Cells and the Hypothalamus.

Neural progenitor cells (NPCs) are multipotent neural stem cells (NSCs) capable of self-renewing and differentiating into neurons, astrocytes and oligodendrocytes. In the postnatal/adult brain, NPCs are primarily located in the subventricular zone (SVZ) of the lateral ventricles (LVs) and subgranular zone (SGZ) of the hippocampal dentate gyrus (DG). There is evidence that NPCs are also present in the postnatal/adult hypothalamus, a highly conserved brain region involved in the regulation of core homeostatic processes, such as feeding, metabolism, reproduction, neuroendocrine integration and autonomic output. In the rodent postnatal/adult hypothalamus, NPCs mainly comprise different subtypes of tanycytes lining the wall of the 3rd ventricle. In the postnatal/adult human hypothalamus, the neurogenic niche is constituted by tanycytes at the floor of the 3rd ventricle, ependymal cells and ribbon cells (showing a gap-and-ribbon organization similar to that in the SVZ), as well as suprachiasmatic cells. We speculate that in the postnatal/adult human hypothalamus, neurogenesis occurs in a highly complex, exquisitely sophisticated neurogenic niche consisting of at least four subniches; this structure has a key role in the regulation of extrahypothalamic neurogenesis, and hypothalamic and extrahypothalamic neural circuits, partly through the release of neurotransmitters, neuropeptides, extracellular vesicles (EVs) and non-coding RNAs (ncRNAs).

Correspondence between development of cytotoxic edema and cerebrospinal fluid volume and flow in the third ventricle after ischemic stroke

ObjectivesThe importance of monitoring cerebrospinal fluid for the development of edema in ischemic stroke has been emphasized; however, studies on the relationship between intraventricular cerebrospinal fluid behavior and edema through longitudinal observations and analysis are rare. This study aimed to investigate the correlation between the development of cytotoxic edema and cerebrospinal fluid volume and flow in the third ventricle after ischemic stroke. Materials and methodsThe ventricle and edema regions were obtained using apparent diffusion coefficients and T2 and subdivided into lateral/ventral 3rd ventricles and cytotoxic/vasogenic (or cyst) edema, respectively. In rat models of ischemic stroke, the volume and flow (via the pseudo-diffusion coefficient [D*]) of the ventricles and edema volumes were longitudinally monitored for up to 45 days after surgery. ResultsThe volume of cytotoxic edema increased in the hyperacute and acute phases, whereas the volume (r = -0.49) and median D* values (r = -0.48 in the anterior-posterior direction) of the ventral 3rd ventricle both decreased, showing negative correlations with the volume of cytotoxic edema. In contrast, the volume of vasogenic edema/cyst was positively correlated with the volume (r = 0.73) and median D* values (r = 0.78 in the anterior-posterior direction) of the lateral ventricle in the subacute and chronic phases. ConclusionsThis study showed that the evolution of cerebrospinal fluid volume and flow in the ventricles was associated with edema progression at different time points in the ischemic stroke brain. This provides an efficient framework for monitoring and quantifying the interplay between cerebrospinal fluid and edema.