Cerebral Manifestations Research Articles

Apheresis therapies in MOGAD: a retrospective study of 117 therapeutic interventions in 571 attacks

BackgroundIncomplete attack remission is the main cause of disability in myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD). Apheresis therapies such as plasma exchange and immunoadsorption are widely used in neuroimmunology. Data...

S100B, GFAP and NSE: The Role of Neuro Biomarkers for Early Predictors of Cerebral Vaso-Occlusive Manifestations of Sickle Cell Disease

S100B, GFAP and NSE: The Role of Neuro Biomarkers for Early Predictors of Cerebral Vaso-Occlusive Manifestations of Sickle Cell Disease

Cerebral manifestation of hypervirulent klebsiella pneumoniae: An in-depth case report on isolated brain abscess

Cerebral manifestation of hypervirulent klebsiella pneumoniae: An in-depth case report on isolated brain abscess

Normal-Tension Glaucoma and Potential Clinical Links to Alzheimer's Disease.

Glaucoma is a group of optic neuropathies and the world's leading cause of irreversible blindness. Normal-tension glaucoma (NTG) is a subtype of glaucoma that is characterized by a typical pattern of peripheral retinal loss, in which the patient's intraocular pressure (IOP) is considered within the normal range (<21 mmHg). Currently, the only targetable risk factor for glaucoma is lowering IOP, and patients with NTG continue to experience visual field loss after IOP-lowering treatments. This demonstrates the need for a better understanding of the pathogenesis of NTG and underlying mechanisms leading to neurodegeneration. Recent studies have found significant connections between NTG and cerebral manifestations, suggesting NTG as a neurodegenerative disease beyond the eye. Gaining a better understanding of NTG can potentially provide new Alzheimer's Disease diagnostics capabilities. This review identifies the epidemiology, current biomarkers, altered fluid dynamics, and cerebral and ocular manifestations to examine connections and discrepancies between the mechanisms of NTG and Alzheimer's Disease.

Vascular Challenges in Behçet's Disease: A Case Report Emphasizing Arterial Involvement

Behçet's disease, characterized by systemic manifestations primarily affecting the vascular system, presents unique challenges in diagnosis and management, particularly when arterial involvement occurs. This case report discusses a 50-year-old patient with Behçet's disease, highlighting the importance of recognizing and addressing arterial complications. The patient, diagnosed with bipolar aphthosis at 49, developed deep venous thrombosis and bilateral panuveitis, showing improvement with corticosteroids, azathioprine, and anticoagulation. A subsequent presentation a year later included deep vein thrombosis, loss of consciousness, and paraparesis, alongside mouth ulcers. Cerebral-medullary MRI revealed inflammatory arterial stenoses and tuberculous spondylodiscitis. A coincidental discovery of pulmonary embolism complicated therapeutic options, with satisfactory evolution following treatment. Discussion emphasizes the intricate nature of Behçet's disease, known for systemic and vascular involvement, especially in arteries. The rarity of cerebral arterial manifestations underscores the need for heightened awareness to diverse morphological presentations. Managing arterial complications requires a tailored therapeutic strategy, balancing immunosuppression and potential risks. Collaborative efforts among specialists are crucial for refining treatment approaches and improving outcomes. In conclusion, this case report underscores the importance of recognizing and addressing arterial complications in Behçet's disease for effective management. Continued research and multidisciplinary collaboration are essential to enhance our understanding and refine therapeutic interventions for this complex systemic disorder.

An update on Behçet's syndrome

Behçet's syndrome (BS, synonym: Behçet's disease, or Adamantiades-Behçet's disease, ABD) is classified as a vasculitis of variable vessel size and can manifest itself in both arterial and venous vessels. Its extensive and at the same time interindividually very different clinical picture is not uncommon a challenge, both with regard to the diagnosis of this rheumatic systemic disease, which is rather rare in our latitudes, and its therapeutic options. In addition to the four cardinal symptoms of recurrent oral aphthae, genital aphthae, skin and eye lesions, the clinical picture offers numerous other manifestations which often require interdisciplinary cooperation. In addition to the above mentioned ocular involvement, which can still lead to blindness if inadequately treated, this is especially true for intestinal and cerebral manifestations as well as for large vessel vasculitis.A final revision of the European League Against Rheumatism recommendations for the management of Behcet's syndrome (EULAR) was made in 2018, and the recommendations are now established internationally as an important treatment guide. Therapy is based on the leading organ involvement. After adalimumab received approval for the treatment of posterior ocular involvement in 2016, another agent, apremilast, became available in 2020. The drug is recommended for the treatment of recurrent oral aphthae in adult Behçet's patients requiring systemic therapy. Nevertheless, there is a further need for new drugs.This article aims to highlight recent findings in the areas of epidemiology, immunopathogenesis & genetics, clinical findings, and therapy, with an emphasis on clinical relevance.

Detection of Spinal Cord Multiple Sclerosis Lesions Using a 3D-PSIR Sequence at 1.5 T.

Multiple sclerosis (MS) is aprevalent autoimmune inflammatory disease. Besides cerebral manifestations, an affection of the spinal cord is typical; however, imaging of the spinal cord is difficult due to its anatomy. The aim of this study was to assess the diagnostic value of a3D PSIR pulse sequencing at a1.5 T magnetic field strength for both the cervical and thoracic spinal cord. Phase sensitive inversion recovery (PSIR), short tau inversion recovery (STIR) and T2-weighted (T2-w)images of the spinal cord of 50patients were separately evaluated by three radiologists concerning the number and location of MS lesions. Furthermore, lesion to cord contrast ratios were determined for the cervical and thoracic spinal cord. Of the lesions 54.81% were located in the cervical spinal cord, 42.26% in the thoracic spinal cord and 2.93% in the conus medullaris. The PSIR images showed ahigher sensitivity for lesion detection in the cervical and thoracic spinal cord (77.10% and 72.61%, respectively) compared to the STIR images (58.63% and 59.10%, respectively) and the T2-w images (59.95% and 59.52%, respectively). The average lesion to cord contrast ratio was significantly higher in the PSIR images compared to the STIR images (p < 0.001) and the T2-w images (p < 0.001). Evaluation of the spinal cord with a3D PSIR sequence at amagnetic field strength of 1.5 T is feasible with ahigh sensitivity for the detection of spinal MS lesions for the cervical as well as the thoracic segments. In combination with other pulse sequences it might become avaluable addition in an advanced imaging protocol.

Brain metastases

Cerebral metastases in patients with metastatic lung cancer are found in more than 30% of patients at baseline and manifest themselves in two out of three patients during disease evolution. For a long time, the cerebral manifestation of the disease was classified as prognostically unfavorable and hence such patients were regularly excluded from therapy studies. In the context of targeted molecular therapy strategies and established immuno-oncological systemic therapies, the blood-brain barrier no longer represents an insurmountable barrier. However, the treatment of brain metastases requires decision making in a multidisciplinary team within dedicated lung cancer and/or oncology centers. The differentiated treatment decision is based on the number, size and location of the brain metastases, neurology and general condition, comorbidities, potential life expectancy and the patient's wishes, but also tumor biology including molecular targets, extra-cranial tumor burden and availability of a CNS-effective therapy. Systemic therapies as well as neurosurgical and radiotherapeutic concepts are now often combined for optimized and prognosis-improving therapeutic strategies.

Congenital toxoplasmosis and audiological outcome: from a case series to a suggestion of patient-based schedule.

Sensorineural hearing loss (SNHL) has been suggested to be possibly related to congenital toxoplasmosis (CT), although its prevalence varies from 0% to 26%. This variance appears to be dependent especially on early timing of treatment. However, the available data are based on outdated studies conducted on small groups of patients that lack homogeneity. Therefore, to establish evidence-based guidelines for audiologic monitoring in CT, we conducted a comprehensive evaluation of a large case series over a long period of time. This is a single-center, retrospective cohort that enrolled all infants and children who were exposed in utero to Toxoplasma gondii and/or congenitally infected between September 1980 and December 2022. They underwent standard serial audiological evaluations to detect possible SNHL at an early stage. The first evaluation was performed during the initial assessment to define the onset of congenital toxoplasmosis, with another evaluation conducted at least at 12 months of life. We collected data from 1,712 patients, and 183 (10.7%) were diagnosed with CT. Among these cases, 78 children (42.6%) presented with symptomatic CT at the onset, exhibiting ocular findings (21.1%), clinical cerebral manifestations (6.1%), and/or abnormal findings on neuroimaging (35.5%). Therapy was administrated at the onset in 164 patients (89.6%) with 115 of them starting treatment prior to 2.5 months of age (0-388, median 32.00 ± 92.352 days of life). Only one patient presented with SNHL at the onset, but this was apparently unrelated to CT. The median number of audiological assessments was 2.2 ± 1.543 (2-10). No patients developed any grade of delayed hearing loss, both in treated and untreated groups. The median age at last audiological evaluation was 2.3 ± 2.18 years (1-8), although the median follow-up period was 12.4 years (±6.3), ranging from 1 to 27 years. Based on these data, it appears that SNHL may be less frequent in CT than previously assumed. We recommend conducting an audiological assessment at the onset (within the first 2.5 months of life) to comprehensively define the type of CT onset, and then conducting another evaluation within 9 months of life.

Rare case of cerebral hemorrhage manifestation in moyamoya disease

Rare case of cerebral hemorrhage manifestation in moyamoya disease

Clinical features of the course of tuberculous meningitis in HIV-infected patients

Background. Central nervous system tuberculosis is one of the most severe forms of extrapulmonary tuberculosis, which is due to an unfavorable clinical course, a high incidence of neurological complications and deaths. Despite this, the problem of early diagnosis is still not solved.&#x0D; Aim. To study the clinical and laboratory-instrumental features of the early diagnosis of tuberculous meningitis in HIV-infected patients.&#x0D; Materials and methods. A retrospective analysis of 31 case histories of patients with tuberculous lesions of the meninges and central nervous system in the late stages of HIV infection who were treated at the Clinical Tuberculosis Dispensary of Krasnodar Territory in 20202022 was carried out. The data of clinical manifestations of the disease, the results of laboratory and instrumental methods of examination were analyzed. Statistical data processing was performed by Microsoft Office Excel 2021 with the calculation of averages, standard deviation.&#x0D; Results. Tuberculous lesions of the meninges and the central nervous system among HIV-infected people were more common in men of working age who were not previously registered in a tuberculosis dispensary. All HIV-infected patients had late stages of HIV infection with severe immunodeficiency: the content of CD4+ lymphocytes less than 100 cells was detected in 45.46%; from 100 to 200 cells/l of CD4+ lymphocytes were recorded in 36.36%, more than 200 cells/l in 18.18%. Also, in all the studied patients, the primary focus was established in the form of tuberculosis of the respiratory organs, represented in 56.52% of cases by disseminated pulmonary tuberculosis. More than 70% had generalized tuberculosis with damage to the kidneys, spleen, and peripheral lymph nodes. A feature of the manifestation of tuberculous meningitis in HIV-infected people can be considered a high frequency of acute increase in neurological symptoms. Of the cerebral manifestations, the most common were: headache, dizziness, photophobia. 13.04% of HIV-infected patients complained of nausea and vomiting. 91.30% showed signs of damage to the substance of the brain, represented by mono-, hemiparesis and damage to the cranial nerves, mainly IIIIV, VI, VII pairs. The composition of CSF in HIV-positive patients revealed the presence of mild pleocytosis (up to 100 cells/l) in 56.52% of cases. The nature of the change in the concentration of proteins, chlorides and glucose is nonspecific.&#x0D; Conclusions. The study revealed the features of medical and social characteristics, clinical and laboratory and instrumental picture of tuberculous meningitis in HIV-infected patients and without HIV infection.

Roles of Omega-3 Polyunsaturated Fatty Acids in Managing Cognitive Impairment in Chronic Obstructive Pulmonary Disease: A Review.

Chronic obstructive pulmonary disease (COPD) contributes significantly to the death of people worldwide, especially the elderly. An essential feature of COPD is pulmonary inflammation, which results from long-term exposure to noxious substances from cigarette smoking and other environmental pollutants. Pulmonary inflammatory mediators spill over to the blood, leading to systemic inflammation, which is believed to play a significant role in the onset of a host of comorbidities associated with COPD. A substantial comorbidity of concern in COPD patients that is often overlooked in COPD management is cognitive impairment. The exact pathophysiology of cognitive impairment in COPD patients remains a mystery; however, hypoxia, oxidative stress, systemic inflammation, and cerebral manifestations of these conditions are believed to play crucial roles. Furthermore, the use of medications to treat cognitive impairment symptomatology in COPD patients has been reported to be associated with life-threatening adverse effects, hence the need for alternative medications with reduced side effects. In this Review, we aim to discuss the impact of cognitive impairment in COPD management and the potential mechanisms associated with increased risk of cognitive impairment in COPD patients. The promising roles of omega-3 polyunsaturated fatty acids (ω-3 PUFAs) in improving cognitive deficits in COPD patients are also discussed. Interestingly, ω-3 PUFAs can potentially enhance the cognitive impairment symptomatology associated with COPD because they can modulate inflammatory processes, activate the antioxidant defence system, and promote amyloid-beta clearance from the brain. Thus, clinical studies are crucial to assess the efficacy of ω-3 PUFAs in managing cognitive impairment in COPD patients.

Potential effects of Chinese herbs on iron metabolism for the treatment of stroke

Stroke has become the second leading cause of death and disability worldwide. Its morbidity and mortality are on the rise, seriously jeopardizing the health and quality of life of the elderly. A growing number of studies have identified ferroptosis as an important mechanism of pathological cell death during stroke and other acute brain injuries, and studies have demonstrated that ferroptosis inhibitors and ion chelators are effective in improving neurological damage and related cerebral ischemia manifestations in the development of stroke. This suggests that there are potential targets in the ferroptosis pathway to regulate stroke. The synergistic effect of Chinese herbs with multiple components, multiple pathways, and multiple targets is a unique advantage for stroke prevention and treatment. The aim of this article is to describe the role and influence of Chinese herbs in the pathology of ferroptosis injury in stroke, and to provide evidence that Chinese herbs can treat or reduce neurological injury after stroke by targeting ferroptosis.

An update on Behçet's syndrome

Behçet's syndrome (BS, synonym: Behçet's disease, or Adamantiades-Behçet's disease, ABD) is classified as a vasculitis of variable vessel size and can manifest itself in both arterial and venous vessels. Its extensive and at the same time interindividually very different clinical picture is not uncommon a challenge, both with regard to the diagnosis of this rheumatic systemic disease, which is rather rare in our latitudes, and its therapeutic options. In addition to the four cardinal symptoms of recurrent oral aphthae, genital aphthae, skin and eye lesions, the clinical picture offers numerous other manifestations which often require interdisciplinary cooperation. In addition to the above mentioned ocular involvement, which can still lead to blindness if inadequately treated, this is especially true for intestinal and cerebral manifestations as well as for large vessel vasculitis.A final revision of the European League Against Rheumatism recommendations for the management of Behcet's syndrome (EULAR) was made in 2018, and the recommendations are now established internationally as an important treatment guide. Therapy is based on the leading organ involvement. After adalimumab received approval for the treatment of posterior ocular involvement in 2016, another agent, apremilast, became available in 2020. The drug is recommended for the treatment of recurrent oral aphthae in adult Behçet's patients requiring systemic therapy. Nevertheless, there is a further need for new drugs.This article aims to highlight recent findings in the areas of epidemiology, immunopathogenesis & genetics, clinical findings, and therapy, with an emphasis on clinical relevance.

Early Diagnosis of Tuberous Sclerosis Complex: Prenatal Diagnosis.

Strong emphasis has been placed recently on early (4 postnatal months) detection of tuberous sclerosis complex and the introduction of antiepileptic treatment before seizure onset. This objective can be achieved prenatally: Cardiac rhabdomyomas and the major diagnostic tuberous sclerosis complex sign are detected during fetal ultrasound, and prenatal MR imaging allows detection of cerebral major manifestations: cortical tubers, subependymal nodules, and subependymal giant cell astrocytomas. We retrospectively reviewed 50 fetuses with ultrasound-detected cardiac tumors at 19-36 gestational weeks (median, 31 weeks). MR imaging with the use of 1.5T scanners was performed at 24-37 gestational weeks (median, 34 weeks). In 11 fetuses (22%), cardiac tumors remained the only criterion. In remaining 39 fetuses (78%), MR imaging revealed a prenatal diagnosis of tuberous sclerosis complex, having shown an additional 1-3 major criteria: subependymal nodules in all cases (39/39 = 100.0%), subependymal giant cell astrocytomas in 6 (6/39 = 15.4%), and cortical tubers in 24 (24/39 = 61.5%). Radial migration lines and cerebellar tuber, not published so far, were shown in 1 case each. A schedule of proper care of children with tuberous sclerosis complex can be established during the perinatal period due to education of women to report for mandatory ultrasound examinations during pregnancy, the good quality of ultrasound, and referral to MR imaging if a cardiac tumor is depicted on ultrasound. Gynecologists and pediatric cardiologists performing fetal ultrasound and radiologists performing prenatal MR imaging are a key to early diagnosis of tuberous sclerosis complex in many cases.

Influenza vaccine is able to prevent neuroinflammation triggered by H7N7 IAV infection.

Influenza A virus (IAV) subtypes are a major cause of illness and mortality worldwide and pose a threat to human health. Although IAV infection is considered a self-limiting respiratory syndrome, an expanded spectrum of cerebral manifestations has been reported following IAV infection. Neurotropic IAVs, such as the H7N7 subtype, are capable of invading the central nervous system (CNS) and replicating in brain cells, resulting in microglia-induced neuroinflammation. Microglial cells, the brain's resident immune cells, are instrumental in the inflammatory response to viral infection. While activation of microglia is important to initially contain the virus, excessive activation of these cells leads to neuronal damage. Previous studies have shown that acute and even long-term IAV-induced neuroinflammation leads to CNS damage. Therefore, the search for possible preventive or therapeutic strategies is of great importance. In this study, we investigated the potential effect of vaccination against acute neuroinflammation induced by H7N7 infection and subsequent neuronal damage in the hippocampus, a particularly vulnerable brain region, comparing young and aged mice. Immunosenescence is one of the striking pathophysiological changes during mammalian aging that leads to "inflammaging" and critically limits the protection by vaccines in the elderly. The results suggest that formalin-inactivated H7N7 vaccine has a preventive effect against the inflammatory responses in the periphery and also in the CNS after H7N7 infection. Cytokine and chemokine levels, increased microglial density, and cell volume after H7N7 infection were all attenuated by vaccination. Further structural analysis of microglial cells also revealed a change in branching complexity after H7N7 infection, most likely reflecting the neuroprotective effect of the vaccination. In addition, synapse loss was prevented in vaccinated mice. Remarkably, engulfment of post-synaptic compartments by microglia can be proposed as the underlying mechanism for spine loss triggered by H7N7 infection, which was partially modulated by vaccination. Although young mice showed better protection against neuroinflammation and the resulting deleterious neuronal effects upon vaccination, a beneficial role of the vaccine was also observed in the brains of older mice. Therefore, vaccination can be proposed as an important strategy to prevent neurological sequelae of H7N7 infection.

Mechanistic insights into immunopathogenesis of murine cerebral malaria: Cues from “young” C57BL/6J and BALB/c mice

Cerebral malaria (CM), a major cause of mortality in children <5 years, presents disparity in pathophysiological features and poor prognosis compared to adults. Adult C57BL/6J mice infected with Plasmodium berghei ANKA (PbA) are widely used to understand CM pathogenesis compared to relatively less prone BALB/c mice; however, age and immune status of the host also influence disease sequelae and cerebral manifestations. Murine models of CM known so far do not project complete disease spectrum of pediatric CM. The present study was designed to dissect and differentiate CM immunopathogenesis in “young” BALB/c and C57BL/6J mice infected with PbA, in search of a competent mouse model mimicking pediatric CM. Multipronged approach including the analysis of blood-brain barrier (BBB) permeability and parasite infiltration, histopathology, nitric oxide levels, and pro/anti-inflammatory (TNF-α, IFN-γ, IL-4, and IL-10) cytokine expression were compared in the cortices of both young BALB/c and C57BL/6J mice. The results illustrate severe course of infection and typical CM like histopathological alterations including monocytic plugging in PbA-infected “young" BALB/c compared to C57BL/6J mice. The decreased expression of tight junction proteins (ZO-1 and Claudin-3) and Evan's blue extravasation was also more evident in BALB/c mice indicating a more permeable BBB. The increased cortical expression of TNF-α, IFN-γ, IL-4, IL-10, iNOS, eNOS, nNOS, and associated activation of brain resident cells in cortices of BALB/c with progressive parasitaemia depicts the cumulative involvement of host immune responses and parasite accumulation in progression of CM. Thus, the incongruity of cytokine balance resulted in worsening of disease manifestation in “young” BALB/c similar to pediatric CM.

Distal middle cerebral artery aneurysm manifestation against the background of COVID-19

A significant part of distal cerebral aneurysms belongs to the category of complex. Traditional methods of shutting down such aneurysms are not applicable. Treatment tactics remain a subject of debate. The presence of COVID-19 complicates the course of the disease and complicates the routing of the patient to a specialized hospital.Description of the case. A 36-year-old man with COVID-19 developed an ischemic stroke in the territory of the right middle cerebral artery (MСA), clinically manifested by dysarthria and pronounced left-sided hemiparesis. Cerebral angiography (CAG) revealed thrombosis of the parietal branch of the M2 segment of the right MСA with distal filling of the channel from the territory of the left MСA. After 3 months, according to the control CAG, recanalization of the M2 segment of the right MСA and fusiform aneurysm of this segment of the artery were diagnosed. To turn off the aneurysm, an intra-intracranial anastomosis was applied between the upper and lower M2 segments of the right MСA and an extra-intracranial anastomosis between the parietal branch of the right superficial temporal artery and the cortical branch from the territory of the compromised M3 segment of the MСA, the aneurysm was excised. The postoperative period was complicated by reinfection of SARS-CoV-2. After the treatment, the patient was discharged in a satisfactory condition without neurological deficit.Discussion. Resection of an aneurysm with revascularization of the distal bed can be considered as the method of choice in patients with distal aneurysms if it is impossible to apply traditional clipping. The presence of COVID-19 infection increases the risk of thrombotic complications, imposes increased requirements on the technique of performing vascular anastomoses.

An unusual case of necrobiotic xanthogranuloma with IgG-λ monoclonal gammopathy presenting as cerebral manifestations.

An unusual case of necrobiotic xanthogranuloma with IgG-λ monoclonal gammopathy presenting as cerebral manifestations.

Microwave Radiothermometry in Evaluating Brain Temperature Changes (Review)

Aim. This review aims to inform physicians of different specialties (anesthesiologists, intensivists, neurologists, neurosurgeons, oncologists) about the diagnostic capabilities of microwave radiothermometry, which enables to identify and analyze features of alterations of cerebral temperature in brain damage.The review displays a critical analysis of 80 recent Russian and foreign open access publications found by keywords.The review presents major clinical features and pathophysiological mechanisms of cerebral thermal balance disruptions in brain lesions. Slow responsiveness and vulnerability of cerebral thermal homeostasis regulation mechanisms that underlie development of different temperature heterogeneity levels in the cerebral cortex in healthy brain and brain lesions are highlighted. The authors postulate their concept about the critical role of hyperthermia in the pathogenesis of brain damage and disruption of interconnections in the global central regulation system. A body of evidence explaining direct association between the depth of consciousness impairment and degree of cerebral cortex temperature heterogeneity manifestation is presented. It is emphasized that a significant increase in temperature heterogeneity with areas of focal hyperthermia accompanies an acute period of ischemic stroke, while in post-comatose state usually associated with prolonged impairment of consciousness, the temperature heterogeneity significantly subsides. It has been suggested that lowering of an increased and rising of the reduced temperature heterogeneity, for example by using temperature exposure, can improve altered level of consciousness in patients with brain damage. The diagnostic capabilities of various technologies used for cerebral temperature measurement, including microwave radiothermometry (MWR), are evaluated. Data on high accuracy of MWR in measurement of the cerebral cortex temperature in comparison with invasive methods are presented.Conclusion. In healthy individuals MWR revealed a distinct daily rhythmic changes of the cerebral cortex temperature, and badly violated circadian rhythms in patients with brain lesions. Since MWR is an easy-toperform, non-invasive and objective diagnostic tool, it is feasible to use this technology to detect latent cerebral hyperthermia and assess the level of temperature heterogeneity disruption, as well as to study the circadian rhythm of temperature changes.