Cerebellar Medulla Research Articles

Increased hindbrain motion in Chiari I malformation patients measured through 3D amplified MRI (3D aMRI)

Chiari Malformation type 1 (CM-I) is a neurological disorder characterized by morphological defects including excessive cerebellar tonsillar ectopia and associated manifestations. We used 3D amplified MRI on a cohort of healthy and CM-I subjects to investigate the brain’s intrinsic motion, its association with the morphology and patient’s symptomatology, and surgical outcomes. We observed that the regional brain motion in CM-I was significantly higher than that of the healthy subjects, with anterior-posterior (AP) and superior-inferior (SI) displacements in cerebellar tonsils and medulla having the highest differences between the healthy and CM-I (∼45%–∼73% increased motion in the CM-I group). Interestingly, we found the ratio of neural tissue in the foramen magnum to be directly correlated with the SI tonsillar motion (r=0.58). Tonsillar herniation was directly correlated with the AP motion of the tonsils (r=0.61), and AP and medial-lateral (ML) motions of the medulla (r=0.66, and r=0.57). Subjects with higher tonsillar ML motion prior to surgery showed improved outcome (p=0.03, and AUC=0.95). Although we did not observe a significant correlation between the brains motion and morphometrics on the CM-I symptoms (perhaps due to our small sample size), illustrative cases increase our hope for the development of a future tool based on brain biomechanics.

Teaching Neuro Images : Prominent spinal cord atrophy and white matter changes in adult polyglucosan body disease

A 48-year-old man of Ashkenazi Jewish descent developed neurogenic bladder and mild cognitive dysfunction. Neurologic examination and CSF analysis were unremarkable. Brain MRI demonstrated white matter changes in the internal capsule, optic radiations, mesencephalon, superior cerebellar peduncles, pons, and medulla (figure 1) and prominent medullary and spinal cord atrophy (figure 2). These findings are classically found in adult polyglucosan body disease (APBD).1 Glycogen branching enzyme GBE1 gene sequencing revealed that the patient was compound heterozygous (c.691+2T>C and c.986 A>C). APBD should be considered in patients with adult-onset leukodystrophy and spinal atrophy; genetic testing is crucial to prevent misdiagnosis with multiple sclerosis and other leukodystrophies.2

Different dosages of methylprednisolone therapy for acute necrotizing encephalopathy of childhood: a 6-year multicenter retrospective study.

Different dosages of methylprednisolone therapy for acute necrotizing encephalopathy of childhood: a 6-year multicenter retrospective study.

Spinal and cranial morphometric features of chiari malformation patients undergoing decompression surgery

Chiari malformation (CM) is characterized by herniation of the cerebellar tonsil(s) and/or medulla oblongata into the spinal canal, resulting in various morphometric abnormalities. The current study aimed to evaluate the magnetic resonance imaging (MRI) findings and morphometric features of the craniocervical region in patients who underwent surgery for CM. Demographic and radiological data were collected from 59 patients who underwent surgery for CM and a control group of 58 randomly selected nonsurgical patients. For between-group comparisons, Continuous variables were described as the mean (±SD) or median (IQR) and categorical variables as frequency (%). The mean age of the control group participants was 33.38 years. The mean age of patients in the CM group at the time of surgery was 33.83 years. The diameter of the foramen magnum, the maximum anteroposterior diameter of the C1 vertebra, the maximum diameter of the spinal canal at the C2 vertebra, and the atlantodental interval were all positively correlated with the total cerebellar tonsil length [r=0.54, 0.37, 0.42, 0.71]. Comparisons of total cerebellar tonsil length with other morphological and clinical variables, including contact between the brainstem and clivus, basilar invagination, preoperative hydrocephalus, remnant cartilage between the odontoid and C2 corpus, and associated craniovertebral junction anomalies, revealed no other significant correlations. CM is associated with many structural anomalies in the brain. However, there is relatively little detail in the existing literature on the morphometric parameters associated with the malformation. The findings of this study provide insights for future research and contribute to knowledge of the morphometric features of CMs in general and CMs in patients requiring surgical management in particular.

Retracted: Clinical Application of Microsurgery Using the Cerebellar Medulla Fissure Approach in Severe Ventricular Hemorrhage with Casting of the Fourth Ventricle and Its Influence on Neurological Recovery.

[This retracts the article DOI: 10.1155/2021/3699233.].

Mechanism of pharmacological effect of Angelica essential oil on anxiety based on network pharmacology and molecular docking


 
 
 
 Purpose: To investigate the pharmacological effect of Angelica essential oil (AEO) on anxiety disorder and the mechanism of action involved, using network pharmacology and molecular docking.
 Method: Chemical compositions of AEO were determined using gas chromatography-mass spectrometry (GC-MS). The potential targets involved in the effect of AEO on anxiety were predicted by searching Bioinformatics databases. Cytoscape software was applied for networks construction. Analysis of Gene Ontology (GO) and pathway was done via R Programming Language, while molecular docking analysis was conducted by Autodock vina software.
 Results: Network analysis showed that there were 10 bioactive components and 34 potential targets. The potential targets were distributed in cerebellar cortex, basic ganglia, hippocampal formation, amygdala, pons and medulla and liver. AEO was involved in multiple biological processes (BP), cell components (CC) and molecular functions (MF) associated with anxiety disorder. Molecular docking revealed good binding affinity between the major bioactive components and targets.
 Conclusion: This study has revealed the pharmacological mechanism involved in the effect of AEO on anxiety, through network pharmacology and molecular docking. The pharmacological mechanism provides a firm theoretical basis for further studies in this area of research.
 
 
 

Clinical Application of Microsurgery Using the Cerebellar Medulla Fissure Approach in Severe Ventricular Hemorrhage with Casting of the Fourth Ventricle and Its Influence on Neurological Recovery.

Objective To investigate the clinical application of microsurgery using the cerebellar medulla fissure approach in severe ventricular hemorrhage with casting of the fourth ventricle and its effect on neurological recovery. Methods A total of 80 patients with severe intraventricular hemorrhage accompanied by casting and dilation of the fourth ventricle who were admitted to the neurosurgery department between July 2019 and December 2020 were randomly divided into an observation group and a control group, with 40 patients in each group. The drainage tube extubation time and length of hospital stay of the two groups were compared. The 3-day hematoma clearance of the two groups was observed. Postoperative consciousness was evaluated by GCS, and the patients' recovery was evaluated by GOS at three months. The activities of daily living (ADL) scores of the two groups were compared to evaluate patients' postoperative self-care ability. The incidence of postoperative complications in the two groups was collected. Independent risk factors for poor prognosis were analyzed by logistics regression. Results The postoperative hospitalization time and the drainage tube extubation time in the observation group were significantly lower than those in the control group. The ratio of hematoma clearance ≥90% in the observation group was significantly higher than that of the control group. Postoperative GCS scores and GOS scores in the observation group were significantly higher than those of the control group. The rate of postoperative complications in the observation group was significantly lower than that of the control group. The rate of good ADL grading in the observation group was significantly higher than that in the control group. Age and surgical method were independent risk factors for poor prognosis. Conclusion Microsurgery using the cerebellar medulla fissure approach can effectively improve the condition of severe ventricular hemorrhage with casting of the fourth ventricle and promote the recovery of patients' neurological function.

The Toxic Effects of Methotrexate on the Cerebellar Cortex of Adult Albino Rats and the Protective Role of Vitamin C: A Light Microscopic Study

Abstract Background: Cerebellum is the region of brain responsible for multiple motor and cognitive functions. It is formed of two cerebellar hemispheres separated by fissures. It is formed of lobes, lobules and folia; each folium is formed of cerebellar cortex and medulla. Methotrexate is anti-metabolic drug used in treatment of cancer, it has neurotoxic effect, and it produces oxidative stress in nervous tissue. Vitamin C is powerful anti-oxidant; it is a powerful free radical scavenger. Aim of Study: The aim of this work is to study the toxic effects of methotrexate and the possible protective role of vitamin C. Material and Methods: In this study, 30 rats are divided in to 3 groups (Group 1) received no treatment. (Group 2) received 10mg/kg methotrexate injected intraperitoneal once time per week foe four weeks. (Group 3) received vitamin C 20mg/kg by intragastric tube every other day for four weeks and methotrexate as same dos of group 2. At the end of experiment, rats are sacrificed and cerebella are taken and processed for light microscopic examination. Results: There are histological changes in group treated with methotrexate (2) in the form of decreased thickness of granular layer. Purkinje cells shows shrinkage in cell bodies, decrease in number, lost mono laminar organization. Molecular layer showed decreased cellularity. After administration of vitamin C, these cellular changes are decreased, molecular and granular cell layer thickness are restored. Conclusion: Methotrexate is a toxic drug, it destroys the cerebellar cortex, but when administrated with vitamin C, its toxicity is decreased.

CLIPPERS, chronic lymphocytic inflammation with pontine perivascular enhancement responsive to steroids: A challenge in neurological practice, clinical landmarks (Review).

Chronic lymphocytic inflammation with pontine perivascular enhancement responsive to steroids (CLIPPERS) is a relatively newly discovered and characterized condition affecting the central nervous system (CNS) that involves the brainstem almost ubiquitously and that focuses primarily on the pons. Characteristically, CLIPPERS represents a combination of clinical symptoms related to the pathology of the brainstem in particular and has a characteristic appearance on magnetic resonance imaging (MRI), with punctate and curvilinear gadolinium enhancement 'peppering' the pons. The lesions can be viewed via neuroimaging with a predominance in the pons and adjacent rhombencephalic structures, such as the cerebellar peduncles, cerebellum, medulla, and middle brain. These lesions may also spread and appear in other areas of the brain such as the thalamus or white matter. As the name suggests, this clinical syndrome responds to immunosuppressive treatment based on glucocorticosteroids (GCSs), expressed as both clinical and radiological improvements. Support for this treatment is required for a long period, since exacerbations may occur without. Thus, the diagnosis of CLIPPERS has garnered increased attention from clinicians and the active exclusion of differential alternative diagnoses is needed. A specific biomarker of serum or cerebrospinal fluid (CSF) for this condition has not been discovered. The pathophysiology of this condition is not fully elucidated, and it is not yet clear whether CLIPPERS is a disease in its own right or is the culmination of several already known syndromes. Clinicians and radiologists should pay close attention to this condition as it is relatively easy to treat and patients can benefit from the early introduction of GCSs, which can produce significant results through long-term immunosuppression. Taking into account previous reports in the literature, which currently include over 50 cases reported as CLIPPERS, this analysis addressed the clinical features, and paraclinical and differential diagnoses of cases described in the literature.

Establishment of nomograms for fetal vermis and brainstem structures in the midsagittal cranial plane by ultrasonography.

To construct nomograms for the fetal cerebellar vermis and brainstem structures obtainable from the midsagittal plane of the brain by two-dimensional sonography. This was a prospective cross-sectional study of 434 healthy fetuses in low-risk singleton pregnancies between 18 and 35 gestational weeks. The following parameters were evaluated in the midsagittal cranial plane; cerebellar vermis anteroposterior diameter (APD), craniocaudal diameter (CCD), pons, midbrain and medulla oblongata APD and tectum length. The measurements were presented as growth charts according to gestational age. The mean ± SD, and 5%, 50%, 95% centile charts according to gestational age for vermis APD and CCD, pons, midbrain and medulla oblongata APD and tectum length were constructed. Pearson's correlation coefficients for vermis CCD and APD, pons, midbrain, medulla oblongata APD and tectum length by gestational week were 0.961, 0.929, 0.918, 0.761, 0.731 and 0.854, respectively (p < 0.0001). The reference data provided in the present study would be helpful in the prenatal diagnosis of challenging fetal conditions with involvement of the brainstem and cerebellum.

Arnold-Chiari Malformation: Core Concepts.

Arnold-Chiari malformation (ACM), a defect that involves downward displacement of the hindbrain and herniation of the cerebellar vermis, tonsils, pons, medulla, and fourth ventricle through the foramen magnum, is the most complex of the 4 types of Chiari malformations. Unique to the other types of Chiari malformations, approximately 95 percent of infants with ACM also present with an associated myelomeningocele (MMC), the most severe form of spina bifida. Among affected infants, those with symptomatic comorbidities incur a significantly higher morbidity and mortality risk. Prompt identification and diagnosis of ACM, as well as evidence-based postnatal and postsurgical nursing and medical care, is critical. Early surgical intervention can repair an existing MMC and restore proper cerebrospinal fluid circulation, which can dramatically improve patient outcomes and quality of life, and reduce disease and health care burden.

Comparative Study of the Distribution and Localization of Neuroglobin Expression in the Mammalian Brain: A Literature Review

Neuroglobin (Ngb) was recently identified as a member of the vertebrate hemoglobin family. Several studies have been conducted on Ngb in mammals, but none have compared its expression and localization among different mammals. This review compared the distribution and localization of Ngb expression and explained the different functions of Ngb in the brains of mammals. Intel’s integrated performance primitive (IPP) analysis was employed to obtain the expression levels in each region of the mammalian brain. Ngb is widely expressed in the adult yak brain and distributed in different areas, similar to its expression in cattle. The relative expression of the Ngb gene in the cerebral cortex (262.69 ± 9.19) was significantly higher than that in the cerebellar cortex (137.00 ± 7.29), hippocampus (1.00 ± 0.22), medulla oblongata (3.43 ± 0.76), striatum (7.65 ± 0.61) and olfactory bulb (2.14 ± 1.22). Findings in the rat brain showed low Ngb protein expression. The mouse brain showed Ngb over expression in a transgenic variant (Ngb-Tg), while in the human brain, the level of Ngb was higher in the hypothalamus, amygdala and pontine tegmental nuclei than in other parts of the brain. The expression levels, distribution and localization of Ngb differ across the brains of different mammals, so it is appropriate to explore the precise distribution and localization of Ngb before comparison or analysis in these mammals.

Bioinformatics Evaluation of SPATA19 Gene Expression in Different Parts of Brain

Background: Determining the expression pattern of testis genes in the brain is essential for understanding tissue functions and correlation or inter-correlation between testis and the brain. In this study, we examined spermatogenesis-associated 19 (SPATA19 gene) expression in 10 parts of the brain with bioinformatics analysis. Materials and Methods: The public dataset GSE46706, including 1231 samples originated from 134 Caucasian individuals, was downloaded from NCBI Gene Expression Omnibus (GEO). SPATA19 gene expression in the cerebellar cortex, frontal cortex, hippocampus, medulla, occipital cortex, putamen, substantia nigra, temporal cortex, thalamus, and white matter was examined against each other using R software and the t-test. Results: Out of 10 brain parts examined, the cerebellar cortex and white matter showed the highest expression, and the temporal cortex showed the lowest expression of the gene. So the cerebellar cortex had a 5.6% and 6.2% increase in gene expression relative to the putamen and temporal cortex with P values of 6.04e-13 and 2.15e-17, respectively. Also, the white matter had a 4% increase in gene expression over the temporal cortex with a P value of 1.89e-13. Conclusion: SPATA19 had more expression in the cerebellar cortex and white matter than other brain parts. These two parts make up the cerebellum.

Brain Lesions in Aging Zoo-Housed Naked Mole-Rats (Heterocephalus glaber).

Naked mole-rats (NMRs) are common in the managed care of zoos and valuable models for aging research. Limited information on NMR neuropathology is available despite many studies regarding their aging physiology. Histologic sections of brain from 27 adult (5-27 years old) NMRs from 2 zoos were reviewed to determine presence or absence of lesions associated with advanced age in humans and other mammals. A majority (23/27; 85%) of NMR brains had cerebral cortical neuronal changes with rounded or angular neurons, cytoplasmic vacuoles containing pale yellow pigment, periodic acid-Schiff (PAS)-positive granules and green autofluorescence, compatible with lipofuscinosis. Less severe lesions were present in cerebellar Purkinje cells, medulla, and hippocampal neurons. The hypothalamic neuropil of all NMRs had scattered variably sized PAS-positive granules and 10 (37%) had larger round bodies consistent with corpora amylacea. The youngest NMRs, 5 to 7 years old, generally had minimal or no cerebrocortical lesions. Further studies will help understand brain aging in this long-lived species.

A Case of Bilateral Hearing Loss.

Case PresentationA 53-year-old male presented to the emergency department with acute onset of bilateral hearing loss as well as vertigo and severe vomiting. The Head Impulse– Nystagmus–Test of Skew exam was indicative of a central neurologic process. Computed tomography angiogram of the head and neck revealed near-total bilateral vertebral artery occlusions in the second and third segments. The patient was admitted for further evaluation; subsequent magnetic resonance imaging revealed multiple areas of infarction in the cerebellar hemispheres, medulla, and occipital lobes.DiscussionThis case describes a unique presentation of a posterior stroke. Common symptoms include vertigo, loss of balance, and vomiting. However, bilateral hearing loss as a prominent symptom is uncommon. Imaging revealed a rare finding of bilateral vertebral artery occlusion.

Clinical value of abnormal MRI findings in patients with unilateral sudden sensorineural hearing loss.

We aimed to determine the relationship of abnormal labyrinthine signals on heavily T2-weighted three-dimensional fluid-attenuated inversion recovery imaging (HF sequence) with hearing impairment and prognosis in patients with sudden sensorineural hearing loss (SSNHL). Patients with unilateral SSNHL underwent magnetic resonance imaging, including pre-contrast HF sequences and post-contrast HF sequences with a 4-hour scan delay after intravenous gadolinium injection. We measured the signal intensity ratio (SIR) of the vestibule and cochlea relative to the cerebellar medulla on post-contrast HF sequences, and analyzed the relationship of SIR with hearing impairment and prognosis. Of 61 patients, 23 (37.7%) showed signal abnormalities on post-contrast HF sequences. Initial hearing loss and hearing recovery were worse in the HF+ group than in the HF- group (P < 0.05). Profound hearing loss was more common in the HF+ group (52.2% vs. 23.7%), while moderate hearing loss was more common in the HF- group (18.4% vs. 0.0%; P < 0.05 for both). The rate of partial recovery was higher in the HF- group (42.1%) than in the HF+ group (13.0%; P < 0.05). The SIRs of the vestibule and cochlea were positively correlated with the severity of hearing loss and hearing recovery, with higher SIRs indicating more severe hearing loss and poor recovery. Labyrinthine signal abnormalities were found on post-contrast HF sequences in 37.7% of patients with SSNHL. These abnormalities were found only in patients with severe-to-profound hearing loss. Increased SIR indicated more severe hearing loss and poor prognosis.

Basilar artery thrombosis due to hyperhomocysteinemia treated conservatively: a therapeutic success

Basilar artery thrombosis is a rare and potentially fatal cause of posterior circulation stroke. Among the various etiologies, hyperhomocysteinemia is crucial and often under diagnosed, especially in developing countries. Authors describe the case of a 15-year male who presented with 1-day history of headache, vomiting and altered mental status. Non-contrast CT Head revealed multiple acute infarcts in posterior circulation of brain. Laboratory investigations revealed hyperhomocysteinemia. Contrast enhanced MRI Brain showed acute infarcts in bilateral cerebellar hemispheres, pons, midbrain, medulla and vermis. MR venography was suggestive of Basilar Artery thrombosis. Thrombolysis was not done due to delayed presentation; hence authors resorted to conservative management with folic acid and vitamin B supplementation. The patient showed gradual clinical improvement and had complete clinical recovery during follow up visit. A favorable outcome with conservative management of basilar artery thrombosis is rarely reported in literature.

Alterations in Functional Connectivity During Different Phases of the Triggered Migraine Attack.

To understand the changes in functional connectivity between brain areas of potential importance in migraine during different phases of the attack. Migraine is a symptomatically heterogeneous disorder. Understanding the possible changes in brain function and, therefore, neurobiology during different phases of the migraine attack is important in developing disease biomarkers and advancing therapeutics. Randomized, double-blind, placebo-controlled, multi-visit experimental study. Subjects aged 18-50years with migraine with and without aura (≤22 headache days per month) were recruited from across the UK using advertising, from both population and hospital clinic samples (n=53). Consented subjects were randomized to a 0.5µg/kg/min nitroglycerin infusion or to placebo over 20minutes across different study visits, during the period February 2015-July 2017.* All subjects were exposed to a nitroglycerin infusion at least on 1 occasion at screening.** For those subjects who consented to participate in imaging visits (n=25), structural T1, T2 and FLAIR sequences and resting state blood oxygen level dependant contrast (rsBOLD) time series, using a multiecho EPI sequence, were conducted over 30-40minutes at baseline and rsBOLD during premonitory symptoms and migraine headache on a 3T General Electric MR750 MRI scanner. For the placebo visit, the imaging was conducted at the same times following infusion in the absence of symptoms. Montreal Neurological Institute (MNI) coordinates were used to characterize identified brain areas of connectivity change. Using repeated measures ANOVA models with time (visit number) and trigger substance (nitroglycerin/placebo) as factors, significant positive functional coupling was found between the thalami bilaterally and the right precuneus and cuneus regions during the nitroglycerin-triggered premonitory phase (T=3.23, peak connectivity change at [-6, -68, 40] for left thalamus, P=0.012 and [-4, -68, 40] for right thalamus, P=0.019). The nitroglycerin-triggered premonitory phase was associated with a change in the direction of connectivity from positive to negative between the pons and the limbic lobe (T=3.47, peak connectivity change at [2, 8, 50], P<0.001). The headache phase of the nitroglycerin-triggered migraine attack was associated with ongoing negative functional coupling between the pons and the cingulate and frontal cortices, and positive functional coupling between the pons and the cerebellar tonsils and medulla (T=3.47, peak connectivity change at [-8, -52, -58], P=0.007). Understanding the functional reorganization between subcortical and cortical brain areas in different phases of the migraine attack provides novel insights into the abnormal sensory processing and integration during migraine, as well as functional correlation with clinical symptoms displayed during each phase. [*Correction added on July 22, 2020 after first online publication: This sentence was revised from, "Consented subjects had a 0.5 μg/kg/min nitroglycerin infusion…".] [**Correction added on July 22, 2020 after first online publication: This sentence was revised from, "… at least on 1 occasion at screening."].

A case of methylprednisolone treatment for metronidazole-induced encephalopathy

BackgroundMetronidazole, a common antimicrobial agent, can induce encephalopathy in rare cases. After discontinuing metronidazole, most patients show clinical improvement. However, in the face of deteriorating conditions, there have done not to have reports of effective drug treatment.Case presentationA 57-year-old man was admitted to our hospital due to dysarthria and ataxic gait after taking metronidazole at the dose of about 32 g for 20 days. Neurological examination showed that his upward and outward movements of bilateral eyeballs were limited, and horizontal and vertical nystagmus were noted. The brain magnetic resonance imaging showed hyper-intensities in the bilateral cerebellar dentate nuclei, medulla oblongata, midbrain and red nuclei in T2W and FLAIR images. However, the patient’s clinical symptoms worsened after drug cessation. High-dose intravenous methylprednisolone pulse therapy was applied, and this led to a drastic improvement of his symptoms and signs.ConclusionsIn our case, we suggest that early methylprednisolone intervention can prevent the progression of metronidazole-induced encephalopathy and accelerate neurological recovery. We infer that the progression of encephalopathy is related to the delayed toxicity caused by high dose or concentration of metronidazole.

Physics of Anaesthesia Made Easy

Arnold chiari malformation (ACM) Type II is a developmental abnormality of the brainstem and cerebellar tonsil, medulla and protrusion of 4th ventricle into cervical spinal canal.