Frontoparietal Region Research Articles

Positron Emission Tomography (PET Scan) in NeuronavigationGuided Biopsy of Complex Brain Tumors

Male patient, 38 years old, with a history of previous surgical intervention in another center for brain lesion in the left fronto-parietal region, who had undergone a biopsy, with a result of failed pathological anatomy (he had no diagnosis). In the neurological examination, the patient was conscious, oriented in the three spheres, without neurological deficit, Glasgow 15/15. In the cranial MRI was observed in the left fronto-parietal subcortical region a hypointense lesion on T1, and an irregular hyperintense image in relation to the midline on T2, which did not uptake the contrast medium. Surgical intervention was performed, with a biopsy guided by the neuronavigation system (Brain Lab Curve) using a trephine less than 1 cm and the target planned by fusion of PET scan choline (Positron Emission Tomography) and contrasted cranial MRI, the most representative sample of the lesion was taken where observed the maximum affinity of the lesion for radioactive choline. The Pathological Anatomy result was low grade Astrocytoma, establishing a diagnosis. Control cranial CT scan 6 hours post-operatively, which determined the planned biopsy sample site. The post-surgical evolution was satisfactory, Glasgow 15/15, without neurological deficit. It has been proposed to continue treatment for these cases. In cases of complex lesions where CT and MRI cannot offer adequate resolution through imaging of the lesion, PET scan choline can offer an option to plan an appropriate biopsy of the lesion and obtain representativeness and obtain the best diagnosis. We recommend the use of PET scan in these cases.

EFFECT OF CHLORAL HYDRATE ON MORPHOLOGICAL CHANGES IN THE NEOCORTEX AND FUNCTIONAL STATE OF OLD MALE RATS

In order to avoid obtaining distorted results at the stage of preclinical study of new pharmaceutical substances and therapeutic strategies, it is necessary to take into account the features and possible influence of the age of the animal and the anesthesia used on the outcome of the experiment. We studied the effect of chloral hydrate on morphological changes in neurons and the reaction of neocortical microglia and the functional state of old male Wistar rats (24 months). Differences were assessed in control rats and in the group using chloral hydrate at the dose required to achieve anesthesia (400 mg/kg animal weight) after 48hours. After the application of chloral hydrate, the surviving animals (mortality rate 37.5%) showed a significant increase in the signs of neurological deficit in the form of motor, sensory and behavioral disorders compared to the rats of the control group. In the fronto-parietal region of the neocortex of the surviving animals, the expression level of the Iba-1 protein was significantly higher than in the control, neurons and microgliocytes with pronounced morphological changes were noted, while their number did not significantly differ from that in the control group. The obtained results suggest that the adverse effect in the early period after anesthesia with chloral hydrate without model surgical intervention in old rats, which manifests itself in the form of a deterioration in the functional state and mortality, can be realized due to the activation of microglia in the fronto-parietal region of the neocortex. However, the process of determining the specific structure of the brain, the activation of microglia in which is more responsible for the formation of neurological disorders, is quite complex and needs further study. In fundamental and preclinical studies of neuroprotective effects, in which old rats are used as the object of study and chloral hydrate is used as an anesthetic, these features must be taken into account.

GLIOMA-12 GLIOSARCOMA: A SERIES OF FOUR CASES TREATED

Abstract INTRODUCTION Gliosarcoma is a rare central nervous system malignancy, characterized by classical biphasic histological pattern with both glial and sarcomatous component. It usually affects fifth and sixth decade of life with slight male preponderance. In this report, we reviewed the clinical and radiological presentation, pathologic diagnosis, and treatment outcomes for a series of 4 patients diagnosed with gliosarcoma. MATERIAL AND METHODS We carried out a retrospective analysis of four patients with gliosarcoma diagnosed between March 2019 and March 2023. Demographic data, clinicopathological data, treatment strategies employed, details of recurrence, and survival patterns are reviewed. RESULTS Four patients, males, respectively aged of 56, 39, 54 and 57 years, presented with signs and symptoms consistent with an expanding intracranial mass,including headache, seizure, hemiparesis. Median duration of presenting symptoms was 3.5 months. The tumor was located in temporo-parieto-occipital region, fronto-parietal region, fronto-temporal region, and temporal region. All patients underwent craniotomy with attempt to achieve gross total surgical resection. Unfortunately, total resection could be achieved in only two patients; remaining two patients underwent subtotal resection. Surgery was followed by adjuvant radiotherapy and temozolomide-based chemotherapy for three patients. All patients died at 1 week, 6 months, 7 months and 10 months. CONCLUSION As gliosarcoma is considered as a variant of glioblastoma, it is treated similarly to glioblastoma but optimum treatment recommendations are yet to be defined. In this series, we have reported four cases of gliosarcoma who have been treated on the lines of glioblastoma. The prognosis is still poor despite aggressive surgical resection and adjuvant multi-modality therapy is given.

Resting-state functional connectivity of the cerebellum-cerebrum in older women with depressive symptoms

BackgroundAlthough there has been much neurobiological research on major depressive disorder, research on the neurological function of depressive symptoms (DS) or subclinical depression is still scarce, especially in older women with DS.ObjectivesResting-state functional magnetic resonance imaging (rs-fMRI) was used to compare functional connectivity (FC) between the cerebellum and cerebral in older women with DS and normal controls (NC), to explore unique changes in cerebellar FC in older women with DS.MethodsIn all, 16 older women with DS and 17 NC were recruited. All subjects completed rs-fMRI. The 26 sub-regions of the cerebellum divided by the AAL3 map were used as regions of interest (ROI) to analyze the difference in FC strength of cerebellar seeds from other cerebral regions between the two groups. Finally, partial correlation analysis between abnormal FC strength and Geriatric Depression Scale (GDS) score and Reminiscence Functions Scale (RFS) score in the DS group.ResultsCompared with NC group, the DS group showed significantly reduced FC between Crus I, II and the left frontoparietal region, and reduced FC between Crus I and the left temporal gyrus. Reduced FC between right insula (INS), right rolandic operculum (ROL), right precentral gyrus (PreCG) and the Lobule IX, X. Moreover, the negative FC between Crus I, II, Lobule IX and visual regions was reduced in the DS group. The DS group correlation analysis showed a positive correlation between the left Crus I and the right cuneus (CUN) FC and GDS. In addition, the abnormal FC strength correlated with the scores in different dimensions of the RFS, such as the negative FC between the Crus I and the left middle temporal gyrus (MTG) was positively associated with intimacy maintenance, and so on.ConclusionOlder women with DS have anomalous FC between the cerebellum and several regions of the cerebrum, which may be related to the neuropathophysiological mechanism of DS in the DS group.

Long-term efficacy of deep brain stimulation of the subthalamic nucleus in patients with pharmacologically intractable epilepsy: a case series of six patients.

Epilepsy is one of the widespread neurological illnesses, and about 20-40% of epilepsy patients are pharmacoresistant. We aimed to assess the long-term efficacy of subthalamic nucleus (STN) deep brain stimulation (DBS) for drug-resistant epilepsy. We included pharmacologically intractable epilepsy patients who had STN-DBS at the Chinese People's Liberation Army General Hospital between June 2016 and December 2018. We retrospectively evaluated pre- and postoperative clinical outcomes, including seizure frequency, seizure type, anti-seizure medication, cognitive function, anatomical target coordinates, stimulation parameters, and adverse events following the surgical procedure. Six patients with a mean follow-up of 49.3 ± 10.2 months, were included. Seizure frequency decreased by an average of 64.0% after STN-DBS at last year follow-up (p = 0.046), and one patient (1/6) achieved seizure-free status. For seizure type, anti-seizure medication, and cognitive function, there were no significant differences between pre-and post-operation (p > 0.05). In terms of stimulation parameters, the pulse width, amplitude, and frequency were 58.3 ± 9.4 μsec, 2.5 ± 0.7 V, and 122.5 ± 15.7 Hz, respectively. None of the patients showed normal electroencephalography during the electroencephalography reexamination. There were no surgery-related complications, and chronic STN stimulation was generally well tolerated in five patients. However, one patient (1/6) had a difficulty of dyskinesia in the right arm. In conclusion, neuromodulation of the STN by DBS is a promising option for patients with pharmacologically intractable epilepsy, especially for whose epileptic zone originates mainly from the frontoparietal region and who are unsuitable for resective surgery. Further prospective multicenter studies with a larger sample size are necessary for further exploration.

Kernel-based Nonlinear Manifold Learning for EEG-based Functional Connectivity Analysis and Channel Selection with Application to Alzheimer’s Disease

Dynamical, causal, and cross-frequency coupling analysis using the electroencephalogram (EEG) has gained significant attention for diagnosing and characterizing neurological disorders. Selecting important EEG channels is crucial for reducing computational complexity in implementing these methods and improving classification accuracy. In neuroscience, measures of (dis) similarity between EEG channels are often used as functional connectivity (FC) features, and important channels are selected via feature selection. Developing a generic measure of (dis) similarity is important for FC analysis and channel selection. In this study, learning of (dis) similarity information within the EEG is achieved using kernel-based nonlinear manifold learning. The focus is on FC changes and, thereby, EEG channel selection. Isomap and Gaussian Process Latent Variable Model (Isomap-GPLVM) are employed for this purpose. The resulting kernel (dis) similarity matrix is used as a novel measure of linear and nonlinear FC between EEG channels. The analysis of EEG from healthy controls (HC) and patients with mild to moderate Alzheimer’s disease (AD) are presented as a case study. Classification results are compared with other commonly used FC measures. Our analysis shows significant differences in FC between bipolar channels of the occipital region and other regions (i.e. parietal, centro-parietal, and fronto-central) between AD and HC groups. Furthermore, our results indicate that FC changes between channels along the fronto-parietal region and the rest of the EEG are important in diagnosing AD. Our results and its relation to functional networks are consistent with those obtained from previous studies using fMRI, resting-state fMRI and EEG.

The Role of Stimuli-Driven and Goal-Driven Attention in Shopping Decision-Making Behaviors-An EEG and VR Study.

The human attention system, similar to other networks in the brain, is of a complex nature. At any moment, our attention can shift between external and internal stimuli. In this study, we aimed to assess three EEG-based measures of attention (Power Spectral Density, Connectivity, and Spectral Entropy) in decision-making situations involving goal-directed and stimulus-driven attention using a Virtual Reality supermarket. We collected the EEG data of 29 participants in 2 shopping phases, planned and unplanned purchases. The three mentioned features were extracted and a statistical analysis was conducted. We evaluated the discriminatory power of these features using an SVM classifier. The results showed a significant (p-value < 0.001) increase in theta power over frontal, central, and temporal lobes for the planned purchase phase. There was also a significant decrease in alpha power over frontal and parietal lobes in the unplanned purchase phase. A significant increase in the frontoparietal connectivity during the planned purchase was observed. Additionally, an increase in spectral entropy was observed in the frontoparietal region for the unplanned purchase phase. The classification results showed that spectral entropy has the highest discriminatory power. This study can provide further insights into the attentional behaviors of consumers and how their type of attentional control can affect their decision-making processes.

Rheumatoid meningitis: a rare neurological complication of rheumatoid arthritis.

To describe the clinical and neuroimaging characteristics of rheumatoid meningitis (RM) in Chinese patients. The patients admitted to our hospital with the diagnosis of RM in the past 8 years were retrospectively analyzed. Six patients with RM were identified among 933 patients admitted with rheumatoid arthritis (RA). The symptoms of meningitis occurred after onset of arthritis in five patients and before onset in one. Headache (n=6), hyperacute focal neurological deficits (n=4) and seizures (n=3) were the most prevalent symptoms. The nadir modified Rankin Scale score was ≥3 in five patients. Rheumatoid factor was elevated in all patients, and interleukin-6 levels in cerebrospinal fluid were dramatically elevated in three of four tested patients. Magnetic resonance imaging of the brain revealed that the meninges were affected in all patients and the cerebral parenchyma was affected in one patient. The lesions were generally located in the frontoparietal region and showed restricted diffusion along the adjacent subarachnoid space. RM occurred during disease-modifying therapy in four patients. In the acute episode, three patients improved on tocilizumab and the other three improved on pulse corticosteroids. For maintenance therapy, two patients received combined therapy of tocilizumab and other immunosuppressive agents, one received adalimumab and methotrexate, and two received low-dose oral corticosteroids with an immunosuppressive agent. Five patients had a good outcome, and one died of Pneumocystis jirovecii pneumonia after stabilization of his neurologic conditions. No relapse of RM occurred on immunotherapy during follow-up. Chinese patients with RM share some remarkable clinical and neuroimaging features and respond well to appropriate immunotherapy. Tocilizumab could be a treatment option for this severe complication of RA.

A RARE TREATABLE CAUSE OF ADULT ONSET SPASTIC PARAPARESIS

pastic paraparesis refers to weakness and stiffness of both lower limbs caused by lesions affecting the Pyramidal tract. It could be due to genetic or acquired etiology. Genetic causes include leukodystophies, Heriditary Spastic Paraplegia (HSP), metabolic disorders etc,. Acquired causes include B12 and folate deficiency , infections like HTLV-1 virus, HIV, neurosyphilis , vascular malformations and so on. Here we encounter a rare treatable cause of spastic paraparesis. A 28 year old male born out of 3o Consanguinous parents with normal developmental history came with insidious onset slowly progressive spastic paraparesis for the past 4 years. Initially at onset he noticed difficulty in getting up from squatting position, which was associated with stiffness of lower limbs. Then he noticed there was slippage of slippers while walking and he was aware about it. Physical examination revealed marfanoid Habitus ,increased tone and exaggerated reflexes involving both lower limbs .Motor power was MRC Grade 4/5 in both lower limbs in both proximal and distal muscles. Ocular Examination revealed Ectopia Lentis. MRI Spine screening was normal. MRI Brain revealed symmetric T2/FLAIR hyperintensities involving periventricular and deep white matter of bilateral frontoparietal region. Possibilities of Primary demyelinating diseases and genetic/degenerative leukoencephalopathies were considered. CSF examination was normal and oligoclonal bands were absent. Clinical Exome sequence testing was done in suspicion of Adult onset leukodystrophy which showed Homozygous MTHFR gene mutation on exon4. Plasma Homocysteine levels were elevated ( 60 µmol/L).Patient was started on Oral Vitamin B12 1500mcg/day, Folic acid and pyridoxine supplementation. Patient showed symptomatic improvement and is under follow up. MTHFR deficiency in adults is a mimicker of leukodystrophies and other white matter disease. It is a potentially treatable disease. Before considering degenerative diseases like HSP, treatable diseases should be considered.

Abstract #1401381: Rare Case of Asymptomatic Multiple Sclerosis Lesions in Hyperprolactinemia

Hyperprolactinemia is associated with established multiple sclerosis (MS) and MS progression/relapse. An association between hyperprolactinemia and asymptomatic MS lesions, also known as radiologically isolated syndrome (RIS), has not been reported. A 29-year-old African American man presented with gynecomastia during a primary care visit. Medical history included prediabetes, hypertension, and obesity. He denied galactorrhea, decrease in libido, blurred vision, fatigue, enlarged hands/feet, hyperpigmentation, depression, easy bruising, skin changes, polyuria, and any neurological symptoms. His physical exam was unremarkable except for bilateral gynecomastia and obesity. Laboratory results revealed elevated prolactin 30.6 ng/mL. Thyroid function test was normal. Magnetic resonance imaging (MRI) brain showed normal pituitary gland size with a 0.3-cm rounded hypo-enhancing region, enhancement of the left optic nerve, and areas of abnormal T2/FLAIR lesion involving the juxtacortical and subcortical white matter in the left temporal region. Enhancements in the right occipitotemporal region and a small juxtacortical lesion in the medial inferior left frontoparietal region were also observed. The patient was referred to endocrinology. His only complaint was fatigue, and physical exam was unremarkable. Repeat prolactin was higher than before at 78 ng/mL. TSH was elevated at 6.44 mIU/mL with a free T4 of 1.03 ng/dL. Labs including ANA, AQP 4, Lyme, HIV, JC virus, and syphilis panel were negative. He was started on cabergoline 0.5 mg twice weekly for treatment of hyperprolactinemia. He was also started on levothyroxine for fatigue, which was attributed to subclinical hypothyroidism. Neurology initiated treatment for MS with diroximel fumarate. Follow-up in 2 months showed a prolactin level of 1 ng/mL and a normal TSH and free T4. The patient will be followed with MRI pituitary surveillance at 1 year and 5 years. This is a very rare case of hyperprolactinemia associated with RIS. The decision to treat the patient for MS was made to prevent or delay potential clinical symptoms or progression to overt disease. One study has noted a 34% risk of conversion of RIS lesions to the first clinical event of MS in 5 years, especially with risk factors like young age and male gender. However, it is still debatable whether RIS lesions progress and should be treated, given that medications used to treat MS are associated with possible side effects including allergic reaction. Follow-up will focus on presence of new neurological symptoms concerning for MS and change in the size of the pituitary lesion.

A Rare Case of Rheumatoid Meningitis (P9-5.024)

<h3>Objective:</h3> To increase awareness of this rare and underrecognized form of aseptic meningitis. <h3>Background:</h3> Rheumatoid meningitis (RM) is a rare disorder that is historically difficult to diagnose given its diverse range of reported clinical presentations and lack of clear pathognomonic findings. RM is typically a diagnosis of exclusion, made only after ruling out alternative infectious and malignant disease. Common laboratory findings include elevated rheumatoid factor (RF) and anti-citrullinated peptide (anti-CCP) antibody. MRI may show leptomeningeal or pachymeningeal involvement, primarily in a frontoparietal location pattern. CSF analysis typically reveals a pleocytosis with a moderate elevation in protein level. Treatment generally consists of high dose steroids followed by immunotherapy. <h3>Design/Methods:</h3> A 69-year-old male with a history of longstanding rheumatoid arthritis on immunosuppressive therapy with methotrexate and recent addition of abatacept presented to our tertiary referral center with progressive neurologic deficits. He initially developed sudden, bilateral sensorineural hearing loss and dizziness with reported normal brain imaging. Six months later, he developed seizures and rapid functional decline with severe cognitive impairment. <h3>Results:</h3> An MRI brain revealed multifocal leptomeningeal and pachymeningeal enhancement with a relatively unremarkable appearance of the subjacent parenchyma, primarily focused in the right frontoparietal region. CSF studies were remarkable for a mild pleocytosis and a moderate elevation in CSF protein. RF was markedly elevated at 227 IU/mL as was anti-CCP antibody at &gt;200 units. Extensive serum and CSF infectious and oncologic testing were negative. He was treated with 5 days of IV methylprednisolone with a rapid improvement in his cognition. Alternative immunosuppressive therapy for RA with methotrexate and rituximab has resulted in sustained functional stability. <h3>Conclusions:</h3> While rare, RM should be considered in the differential of a patient with aseptic meningitis of unclear etiology, with or without a history of rheumatoid arthritis. Early detection and treatment are essential to the prevention of long-lasting sequela of the disease. <b>Disclosure:</b> Dr. Schmoll has nothing to disclose. Dr. Rodenbeck has nothing to disclose. Dr. Graner has nothing to disclose.

A clinical case report of Balamuthia granulomatous amoebic encephalitis in a non-immunocompromised patient and literature review

BackgroundBalamuthia granulomatous amoebic encephalitis (GAE) is a peculiar parasitic infectious disease of the central nervous system, about 39% of the infected Balamuthia GAE patients were found to be immunocompromised and is extremely rare clinically. The presence of trophozoites in diseased tissue is an important basis for pathological diagnosis of GAE. Balamuthia GAE is a rare and highly fatal infection for which there is no effective treatment plan in clinical practice.Case presentationThis paper reports clinical data from a patient with Balamuthia GAE to improve physician understanding of the disease and diagnostic accuracy of imaging and reduce misdiagnosis. A 61-year-old male poultry farmer presented with moderate swelling pain in the right frontoparietal region without obvious inducement three weeks ago. Head computed tomography(CT) and magnetic resonance imaging(MRI) revealed a space-occupying lesion in the right frontal lobe. Intially clinical imaging diagnosed it as a high-grade astrocytoma. The pathological diagnosis of the lesion was inflammatory granulomatous lesions with extensive necrosis, suggesting amoeba infection. The pathogen detected by metagenomic next-generation sequencing (mNGS) is Balamuthia mandrillaris, the final pathological diagnosis was Balamuthia GAE.ConclusionWhen a head MRI shows irregular or annular enhancement, clinicians should not blindly diagnose common diseases such as brain tumors. Although Balamuthia GAE accounts for only a small proportion of intracranial infections, it should be considered in the differential diagnosis.

Abstract Number ‐ 84: Importance of Early Detection and Treatment of Traumatic Intracranial Pseudoaneurysms Prior to Decompressive Hemicraniectomy

Introduction Intracranial pseudoaneurysms are rare lesions that represent less than 1% of all intracranial aneurysms.1They typically occur due to disruption of the arterial wall layers and subsequent extramural/extraluminal hematoma formation following traumatic brain injury, resulting in a higher risk of rebleeding than that of saccular cerebral aneurysms.2Pseudoaneurysms have higher incidence in children and young adults, and given their association with high morbidity and mortality, early detection and management is essential.2‐4The purpose of this study is to highlight the importance of early recognition and management of traumatic pseudoaneurysms prior to decompressive hemicraniectomy. Methods This is a case report of a six‐year‐old previously healthy male who presented as a level 1 trauma alert after sustaining a gunshot wound to the face while manipulating an unsecured weapon at his residence. Upon arrival, lack of airway protection requiring intubation, entry wound to the anterior forehead, and diffuse forehead and periorbital edema were observed. CT head demonstrated multicompartmental hemorrhage with 6mm right to left midline shift and diffuse cerebral edema. CTA head and neck noted possible thrombosed right anterior cerebral artery (ACA) pseudoaneurysm in the right frontoparietal region (Figure 1‐A). Prior to decompressive hemicraniectomy, neuro‐endovascular consultation was obtained, and emergent cerebral angiogram was recommended. This case highlights the findings demonstrated on cerebral angiography, the technique by which the pseudoaneurysm was detected and secured, and the importance of doing so prior to further neurosurgical interventions. Results The patient was taken for diagnostic cerebral angiogram via femoral artery access. Initial angiographic run of the right internal carotid artery demonstrated distal right pericallosal artery slowing without clear evidence of underlying vascular injuries. Given concern for underlying thrombosed pseudoaneurysm and its parent branch, selective catheterization of the proximal pericallosal artery off the distal ACA was performed. Gentle angiographic run was obtained via microcatheter that demonstrated superior parietal artery pseudoaneurysm without active extravasation (Figure 1‐B). The microcatheter was advanced and placed in the proximal portion of the pseudoaneurysm sac and five platinum coils were deployed to fully obliterate the pseudoaneurysm and its parent feeder while protecting the adjacent paracentral artery (Figure 1‐C, 1‐D). Following completion of the endovascular procedure, the patient was transferred to the operative room for right decompressive hemicraniectomy and clot evacuation, which were completed successfully. Conclusions Prompt detection and securement of traumatic intracranial pseudoaneurysms are essential prior to invasive neurosurgical interventions to reduce risk of recurrent bleeding. Selective angiographic evaluation of the parent injured vessel(s) is crucial for optimal assessment of the underlying lesion. Neuro‐endovascular interventions including coil embolization, stenting, flow‐diverter implantation, and parental artery occlusion have emerged as alternatives to conventional neurosurgical management.2 This case highlights the successful early detection and treatment of a traumatic intracranial pseudoaneurysm with coil embolization followed by uncomplicated decompressive hemicraniectomy.

BILATERAL DECOMPRESSIVE CRANIECTOMY IN A PATIENT WITH HEAD INJURIES DUE TO GUN PROJECTILE: A CASE REPORT

A 38-year-old male patient with multiple skull injuries caused by a small-caliber firearm projectile whose entry hole was the right eye after being attacked when leaving his home. Consequently, he presented head trauma with multifragmented fracture of the cranial vault causing exposure of the brain mass in the bilateral frontoparietal region and complete injury to the right eyeball with fracture of the orbit in its posterior, lateral, medial, roof and floor walls. He was transferred to the General Hospital of Axapusco, where the patient was received with 8 points on the Glasgow scale and a simple tomography of the skull was performed, observing injury to both hemispheres, bilateral subarachnoid hemorrhage, parasagittal hemorrhagic contusions and cerebral edema, predominantly affecting to the corpus callosum and cingulum. Therefore, hinge-type decompressive craniectomy and debridement in the first 12 hours of trauma were determined as surgical treatment. It should be noted that a favorable recovery was obtained without associated complications. It is concluded that the surgical treatment of choice is early decompressive craniectomy when the patient presents less than 9 points on the Glasgow Coma Scale at admission, the injury along the path of the wound is bihemispheric and posterior fossa, the time that elapses from the injury to the performance of the surgery is within the first 12 hours, there is pupillary reactivity and the age of the patient is greater than 35 years.

Imaging Findings on Head Computed Tomography Scans in Victims of Intimate Partner Violence.

The aim of the study is to analyze the imaging findings and injury patterns seen on head computed tomography (CT) examinations performed on survivors of intimate partner violence (IPV). An institutional review board-approved retrospective analysis of 668 patients reporting IPV to our institution's violence intervention and prevention program between January 2013 and June 2018 identified 40 unique patients with radiological findings visible on head CT. All injuries visible on head CT were analyzed based on the anatomic location and injury type. Demographics, IPV screening at the time of injury, concomitant, prior, and subsequent injuries to the index head injury were also recorded. Our study cohort had 36 women and 4 men with a mean age at presentation of 43 ± 13 years (mean ± SD), 91 unique injuries with 57 (62.6%) isolated soft tissue injuries, 4 (3.2%) fractures, 13 (14.3%) intra-axial, and 17 (18.7%) extra-axial injuries. Soft tissue injuries and intra-axial injuries occurred most commonly in the frontal region (45.6% and 38.5%), followed by the parietal region (22.8% and 23.1%), while most extra-axial injuries were subdural hematomas (41.2%). Left-sided injuries accounted for 49% (45/91) with 29/91 right-sided (32%) and 17/91 bilateral (19%) injuries. The IPV screening occurred in 44% of injury visits (22/50). Concomitant injuries were seen in 14/50 injury visits (28%), most commonly being in the lower extremity (6/14, 42.9% [% of visits with concomitant injuries]) followed by the upper extremity (5/14, 35.7%), while 52% of visits (26/50) were preceded by prior injuries and 68% of events (34/50) were followed by subsequent injuries. Isolated soft tissue swelling is the most common manifestation of IPV on head CT scans with frontoparietal region being the most common site. Synchronous and metachronous injuries are frequent.

Pansinusitis, complicated by extensive osteonecrosis of the upper jaw and secondary rhinogenic intracerebral abscess of the right fronto-parietal region of the brain after a COVID-19 (clinical case)

The number of complications of new coronavirus infection (COVID-19) has been growing in clinics of maxillofacial surgery and otorhinolaryngology in the past two years. Among them, lesions of the jaw bones, nasal bones and paranasal sinuses are predominate. As a result of the studies, it was found that with coronavirus infection, multiple microvascular and macrovascular disorders occur, resulting in necrosis of the jaws and paranasal sinuses, often leading to life-threatening conditions, due to the anatomical proximity of brain structures. The article presents a cli-nical observation of a patient with extensive osteonecrosis of the upper jaw, which developed against the background of postcovid purulent pasinusitis, complicated by a secondary rhinogenic intracerebral abscess of the right fronto-parietal region of the brain. The provoking factors, the most characteristic symptoms, the X-ray picture at different stages of the disease, the tactics of treating such complications are considered.

Epidural Pulsation Accelerates the Drainage of Brain Interstitial Fluid.

Unhindered transportation of substances in the brain extracellular space (ECS) is essential for maintaining brain function. Regulation of transportation is a novel strategy for treating ECS blockage-related brain diseases, but few techniques have been developed to date. In this study, we established a novel approach for accelerating the drainage of brain interstitial fluid (ISF) in the ECS using minimally invasive surgery, in which a branch of the external carotid artery is separated and implanted epidurally (i.e., epidural arterial implantation [EAI]) to promote a pulsation effect on cerebrospinal fluid (CSF) in the frontoparietal region. Tracer-based magnetic resonance imaging was used to evaluate the changes in ISF drainage in rats 7 and 15 days post-EAI. The drainage of the traced ISF from the caudate nucleus to ipsilateral cortex was significantly accelerated by EAI. Significant increases in the volume fraction of the ECS and molecular diffusion rate were demonstrated using the DECS-mapping technique, which may account for the mechanisms underlying the changes in brain ISF. This study provides a novel perspective for encephalopathy treatment via the brain ECS.

Echinococcus Infestation of the Central Nervous System as the Primary and Solitary Manifestation of the Disease: Case Report and Literature Review

Introduction: Hydatid disease of the central nervous system, especially when there is no involvement of other organs, is a rare occurrence and it accounts for 2–3% of all the hydatid cyst cases that are recorded worldwide. Echinococcus is considered as an endemic disease, mainly encountered in sheep and cattle-raising regions, with a large proportion of patients living in Mediterranean countries, as well as Turkey and Syria. Pediatric neurosurgeons in nonendemic countries are facing a differential diagnostic challenge when a patient with hydatid cyst of the central nervous system is admitted to their department, mainly due to lack of awareness. Materials and Methods: We report the case of an eleven years old patient, coming from a village, who was admitted to our hospital due to progressive hemiparesis, hemianopsia, headache and episodes of vomiting. A thorough laboratory and neuroimaging investigation was performed, which revealed the presence of a hydatid cyst at the right fronto-parietal region. An en-block total resection was performed and the patient neurological signs and symptoms were immediately relieved. Conclusions: The clinical features related to hydatid cyst involving the central nervous system are largely nonspecific. Nevertheless, MRI has proved to be a very important diagnostic tool, significantly enhancing the diagnostic aid of neuroimaging and supporting our pre-operative diagnostic accuracy. Laboratory investigation with immunological tests may be indicative, but negative results should be interpreted with caution. En block removal of the cyst without interruption of its wall and avoidance of any spillage of content is our ultimate therapeutic goal. Infection with Echinococcus granulosus should be included in the differential diagnosis for non-specific neurologic symptoms such as progressive headache, especially in pediatric patients who are coming from regions which are considered as endemic for such parasitic diseases. In addition, the adjuvant therapy with albendazole is strongly indicated. The majority of misdiagnoses or delayed diagnoses may have resulted from confusing clinical features and atypical radiographic findings.

Uncredited intravascular large B cell lymphoma involving central nervous system: a great masquerader

Background: Intravascular large B-cell lymphoma (IVLBCL) is infrequent and aggressive, clinically depicted by an almost exclusive growth of large cells within the lumen of blood vessels of all sizes. The clinical manifestations are diverse, encompassing many non-specific signs and symptoms such as fever of unknown origin, neurological symptoms, and skin lesions. Case Presentation: We report a case of a 49-year-old lady with unusual IVLBCL of the central nervous system. She presented with rapidly progressive dementia preceded by seizures and a short history of altered sensorium. There were no cutaneous lesions. Plain computed tomography brain showed no significant abnormalities. Cerebrospinal fluid analysis was normal except for mildly raised protein. Antinuclear antibody was positive 1:320 but the remaining autoimmune workups were negative. Electroencephalogram showed cortical dysfunction with occasional sharp wave at the right frontoparietal region. Other dementia workups were unremarkable. Magnetic resonance imaging brain revealed non-enhanced biparietal gyri hyperintensities which may represent encephalitis changes. She was empirically treated for viral encephalitis, however, there were still recurrent seizures despite adequate anti-seizure medications with minimal improvement of symptoms. Subsequent admissions noticed bicytopenia with elevated lactate dehydrogenase. Bone marrow aspirations and trephine biopsy disclosed High-Grade Mature B Cell Lymphoma germinal center B-cell Type. She was subsequently managed by the hematology team and started with conventional rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisolone therapy. Fortunately, she is currently on the road to recovery. Conclusion: High index of suspicion is warranted to diagnose early in order to have a better prognosis.

KERNOHAN’S NOTCH PHENOMENON IN AN ACUTE COMPONENTED CHRONIC SUBDURAL HEMATOMA PATIENT: A CASE REPORT

Kernohan's notch phenomenon is a rare examination finding in cases diagnosed as an intracranial space-occupying lesion. The localization of the space-occupying lesion in this clinical status, which is considered as a sign of herniation, is on the opposite side of the predicted side. The most typical finding is motor deficit and mydriasis on the same side as the space-occupying lesion. A 61-year-old female patient was evaluated in the emergency department due to sudden loss of consciousness. Her neurological examination revealed anisocoria and right hemiparesis findings, including mydriasis in the right pupil. Cranial computed tomography examination revealed a large, acute component combined with chronic subdural hematoma in the right frontoparietal region and midline shift. Clinical and radiological findings were evaluated as Kernohan’s Notch Sign phenomenon. The patient, who was operated on urgently, was discharged on the 7th postoperative day without any neurological deficits.