Parieto-occipital Regions Research Articles

Abstract- Poster

1)Subdural hygromas are fluid collections within the subdural space that are clear or only slightly xanthochromic or blood tinged. They can be caused by mechanical trauma, meningeal or parameningeal infection, or venous congestion. Common presentation of SDH are fever, headache, nausea,vomiting, confusion.2)Here we report a 48 year old male who came with complaints of aggressiveness, forgetfulness, disturbed sleep. Further patient started developing dysarthria,inattention and memory was impaired.3)Neuroimaging- MRI brain showed subdural hygroma in bilateral fronto temporal parieto occipital region.4)Neurosurgery opinion obtained which is unremarkable5)Patient then started regaining his verbal fluency,memory and aggression settled in a span of 3 weeks.Although SDH is common among 1/3rd of patients with head injury/trauma,it is very rare that SDH presents with such features.References 1) SUBDURAL HYGROMA PRESENTING AS DEMENTIA WITH KLUVER-BUCY SYMPTOMS HARPREET S. DUGGAL, CHRISTODAY R.J.KHESS & S. HAQUE NIZAMIE2) Cognitive Impairment in the Elderly with Chronic Subdural Hematoma Hyun Hee Ye, MD, Jeong Ho Kim, MD, Yoon Suk Kim, MD,

Paraparesis as a Rare Complication of Dengue Fever Causing Spontaneous Spinal Subarachnoid Haemorrhage

A smaller number of confirmed dengue cases worldwide present with neurological symptoms such as headache, seizure, neck stiffness, drowsiness, altered sensorium, behavioural disorders, delirium, cranial nerves palsies, and rarely, spinal cord involvement. This report is about a 54-year-old female patient with dengue, who presented with acute spinal cord compression due to spontaneous spinal Subarachnoid Haemorrhage (SAH). She complained of sudden onset of febrile illness associated with headache, myalgia, retro-orbital pain, and low backache for three days, followed by sudden onset paraplegia three days after the onset of the illness. A haemogram was obtained, which showed a platelet count of 60,000/µL. She had antibodies against dengue NS1 and dengue Immunoglobulin M (IgM), but not against dengue IgG. A Magnetic Resonance Imaging (MRI) spine contrast imaging revealed a spinal SAH from the level of T12 to L1, as well as significant cord compression. An MRI of the brain revealed a SAH in the bilateral parieto-occipital region. She underwent an emergency laminectomy and complete haematoma evacuation. Postsurgical period was uneventful with complete recovery of sensation and weakness. In patients from endemic areas of dengue infection who present with fever and spinal cord involvement a high degree of suspicion of this disease should arise and it should always be investigated further for dengue-related neurological complications.

EEG features in patients with Parkinson's disease during directional perception of olfactory stimuli

Introduction. Olfactory dysfunction is considered to be an early and relatively important marker of Parkinson's disease (PD). Olfactory studies using objective neurophysiological methods may become one of the diagnostic tests to identify individuals with a high risk of developing PD.
 The aim of the study was to assess the spectral and topographic characteristics of bioelectrical brain activity in patients with PD during directional perception of olfactory stimuli.
 Materials and methods. This study included 30 patients with PD (mean age was 66.5 6.5 years). The control group consisted of 20 people without PD (mean age was 65.3 8.5 years). Lavender oil, clove oil, camphor oil and -mercaptoethanol solution (an aversive stimulus) were used for olfactory stimulation, while distilled water was used as a control test. The test subject sat with their eyes closed and inhaled the presented smell for 30 seconds, while an EEG recording was made during this time.
 Study results. Olfactory stimulation in patients with PD showed increased synchronicity of the 3 rhythm in the right hemisphere, as well as the rhythm in the parieto-occipital regions of both hemispheres. These changes indicate significant activation of internal (endogenous) attention, increased overall, non-specific readiness potential, as well as the involvement of the limbic-reticular complex in olfactory perception. Olfactory perception in the control group was accompanied by reduction in the 1 rhythm amplitude in the parieto-occipital regions bilaterally, which may indicate moderate activation of external (exogenous) attention and the posterior attention system responsible for simple perception processes.
 Conclusion. Increased 3 rhythm amplitude in the right hemisphere and increased rhythm amplitude, observed during directional olfactory perception, may indicate olfactory dysfunction and should be viewed as an additional indicator when establishing a diagnosis of Parkinsons disease.

Large cavernous malformations in infant

Cavernous malformations are rare vascular malformations in the central nervous system. We present the case of a 2-month-old female patient who presented tonic-clonic seizures, with no previous history of seizures. Magnetic resonance imaging showed a 5.6 cm tumor in the left parieto-occipital region. The radiological aspect of the tumor initially suggested an anaplastic meningioma. After surgical treatment and anatomopathological analysis, it was found to be a cavernous malformation. Cavernous malformations, or cavernomas, are rare lesions and even more rare is the occurrence of large cavernomas. In the pediatric population, although still quite rare, they usually are presented as larger cavernomas. Surgical resection is considered the most effective treatment.

Neurotoxic complications of chemotherapy in children: posterior reversible encephalopathy syndrome

Introduction. The syndrome of posterior reversible encephalopathy syndrome (PRES) is a clinical-radiological condition caused by vasogenic brain edema due to elevated blood pressure. The development of this syndrome is associated with the toxic effect of drugs in the treatment of oncological diseases. In most cases, timely diagnosis and therapy of PRES determine the complete reversibility of symptoms. However, a poor prognosis is possible with the development of severe disabling consequences or death. In practice, there are difficulties in the diagnosis of PRES due to the lack of specificity of clinical manifestations and awareness of many doctors about the existence of this syndrome.The aim of the study was to present the clinical-radiological aspect of the syndrome of posterior reversible encephalopathy in children with oncological diseases.Materials and methods. The analysis of 8 medical histories of children with oncological pathology complicated by the syndrome of posterior reversible encephalopathy was carried out.Results. The study group was dominated by patients with hemato-oncological diseases. The development of PRES occurred during chemotherapy and in most cases was not associated with arterial hypertension. The clinical picture was dominated by such symptoms as impairment of consciousness, seizures and movement disorders in the form of paresis. When carrying out magnetic resonance imaging (MRI), the lesion of the white matter of the brain was determined, mainly in the projection of the parieto-occipital regions. During treatment, all patients showed reversibility of neurological symptoms with leveling of radiological signs.Discussion. When analyzing the clinical and radiological characteristics of PRES in children, a comparison of the data with clinical observations presented in the literature was noted. The role of chemotherapy as a triggering factor in the development of posterior reversible encephalopathy syndrome has been determined.Conclusion. The necessity of including the syndrome of posterior reversible encephalopathy in the list of differential diagnoses in patients receiving chemotherapy is shown.

White matter hyperintensities are associated with grey matter atrophy and cognitive decline in Alzheimer's disease and frontotemporal dementia

White matter hyperintensities (WMHs) are commonly assumed to represent non-specific cerebrovascular disease comorbid to neurodegenerative processes, rather than playing a synergistic role. We compared the impact of WMHs on grey matter (GM) atrophy and cognition in normal aging (n = 571), mild cognitive impairment (MCI, n = 551), Alzheimer's dementia (AD, n = 212), fronto-temporal dementia (FTD, n = 125), and Parkinson's disease (PD, n = 271). Longitudinal data were obtained from ADNI, FTLDNI, and PPMI datasets. Mixed-effects models were used to compare WMHs and GM atrophy between patients and controls and assess the impact of WMHs on GM atrophy and cognition. MCI, AD, and FTD patients had significantly higher WMH loads than controls. WMHs were related to GM atrophy in insular and parieto-occipital regions in MCI/AD, and frontal regions and basal ganglia in FTD. In addition, WMHs contributed to more severe cognitive deficits in AD and FTD compared to controls, whereas their impact in MCI and PD was not significantly different from controls. These results suggest potential synergistic effects between WMHs and proteinopathies in the neurodegenerative process in MCI, AD and FTD.

Impairment of auditory integration in subjective cognitive decline, amnestic mild cognitive impairment, and Alzheimer’s disease

AbstractBackgroundLocalization of sound sources in a noisy environment or ‘auditory scene analysis’ depends on central auditory processing (CAP) that is vulnerable in cognitive impairment. Here, we investigated the behavioral and electrophysiological characteristics of auditory integration, as a particular function in CAP, in relation to neuropsychological functions in SCD, aMCI, and AD.MethodWe introduced a binaural integration paradigm to measure sound‐localization‐related features (identification and retention of acoustic signals) by detecting break in interaural correlation (BIC) and primitive auditory memory (PAM) in wideband noises. We used a 128‐channel EEG to record the event‐related‐potential (peak amplitude, peak latency, and inter‐trial phase coherence [ITPC]) for the paradigm.ResultA total of 121 participants (mean age 65.9 years) were included. Significant differences in BIC detection and PAM were revealed between groups adjusting for age and gender (BIC: F = 20.2, P < 0.001; PAM: F = 24.6, P < 0.001). Post‐hoc analysis showed that BIC detection and PAM were significantly higher in NC or SCD groups compared with aMCI or AD groups. Further adjusting for neuropsychological scores, the significances were not changed, suggesting that auditory integration impairment was partially independent from top‐down cognitive functions. In EEG experiment, the most prominent differences in EEG metrics among the four groups included the ITPC of N1 at left parietooccipital region (F = 3.85, P = 0.012) and of P2 at left parietooccipital (F = 3.89, P = 0.011) and frontocentral regions (F = 8.09, P < 0.001). Notably, there was a linear decrease for the ITPC of N1 and a U‐shape‐curve change for the ITPC of P2 among the four groups, indicating that EEG patterns are differentially modulated depending on disease severity. For the discrimination of AD vs NC and MCI vs NC, the AUC was 0.92 and 0.85 for BIC detection; 0.94 and 0.90 for PAM, respectively.ConclusionAuditory integration, as a partially independent phenotype, is impaired in aMCI and AD populations. A U‐shape‐curve change of P2 with the increasing disease severity was found, indicating a compensation on auditory scene analysis. Results support binaural integration paradigm as a biomarker for screening cognitive decline and identifying auditory integration deficit.

What's "up"? Impaired Spatial Preposition Processing in Posterior Cortical Atrophy.

This study seeks to confirm whether lesions in posterior regions of the brain involved in visuo-spatial processing are of functional relevance to the processing of words with spatial meaning. We investigated whether patients with Posterior Cortical Atrophy (PCA), an atypical form of Alzheimer’s Disease which predominantly affects parieto-occipital brain regions, is associated with deficits in working memory for spatial prepositions. Case series of patients with PCA and matched healthy controls performed tests of immediate and delayed serial recall on words from three lexico-semantic word categories: number words (twelve), spatial prepositions (behind) and function words (e.g., shall). The three word categories were closely matched for a number of psycholinguistic and semantic variables including length, bi-/tri-gram frequency, word frequency, valence and arousal. Relative to controls, memory performance of PCA patients on short word lists was significantly impaired on spatial prepositions in the delayed serial recall task. These results suggest that lesions in posterior parieto-occipital regions specifically impair the processing of spatial prepositions. Our findings point to a pertinent role of posterior cortical regions in the semantic processing of words with spatial meaning and provide strong support for modality-specific semantic theories that recognize the necessary contributions of sensorimotor regions to conceptual semantic processing.

Iant extradural dermoid cyst in the right parietal-occipital region with obliteration of the transverse sinus

The study objective – to report a case of giant extradural dermoid cyst in a 48‑year-old woman; the cyst caused extensive erosion of the occipital bone and lower portions of the right parietal bone, which is quite rare.Case report. A 48‑year-old female patient was admitted to the Department of Neurosurgery, A. Ya. Kozhevnikov Clinic of Nervous System Diseases, University Clinical Hospital No. 3, I. M . Sechenov First Moscow State Medical University on 28.07.2020. In 2002, the patient noted the emergence of a 1‑cm subcutaneous formation in the right occipital region. The formation was slowly growing. On 17.12.2015, she underwent magnetic resonance imaging of the brain. It revealed a 2,5 × 4,4 × 4,0 cm extradural formation with clear contours and erosion of the occipital and right parietal bones. On 12.03.2020, she had contrast-enhanced magnetic resonance imaging, which demonstrated that the tumor was growing (its size was 3,0 × 6,4 × 5,5 cm). Magnetic resonance imaging scans also showed extensive erosion (6,4 × 5,4 cm) of the occipital and right parietal bones and obliteration of the right transverse sinus. On 28.07.2020, the patient underwent elective surgery, namely excision of the extradural dermoid cyst in the right parietooccipital region with simultaneous reconstruction of the calvarial bones using a titanium plate. The cyst capsule and its contents were completely removed. The capsule was tightly attached to the dura mater, but did not invade it. To remove small fragments of the capsule that could potentially invade the bone, we performed small marginal resection of the calvarial bones at the depth of 2–3 mm from the defect margin. After the removal of cyst capsule, well-defined furrow could be visualized on the dura mater in the projection of the obliterated transverse sinus. Five days postoperatively, the patient was discharged from hospital in satisfactory condition.Conclusion. Surgical treatment of extradural dermoid cysts implies radical removal of the tumor. Since the cyst capsule gets tightly attached to the edges of the bone defect along with bone erosion, the removal of such cysts as a single block is almost impossible. The risk of severe erosion of the skull bones caused by a dermoid cyst with extradural (and sometimes intradural) growth increases with age. Therefore, it is recommended to remove such tumors as early as possible. Patients with skull bone defects also require cranioplasty.

Personalized Theta and Beta Binaural Beats for Brain Entrainment: An Electroencephalographic Analysis.

Binaural beats (BB) consist of two slightly distinct auditory frequencies (one in each ear), which are differentiated with clinical electroencephalographic (EEG) bandwidths, namely, delta, theta, alpha, beta, or gamma. This auditory stimulation has been widely used to module brain rhythms and thus inducing the mental condition associated with the EEG bandwidth in use. The aim of this research was to investigate whether personalized BB (specifically those within theta and beta EEG bands) improve brain entrainment. Personalized BB consisted of pure tones with a carrier tone of 500 Hz in the left ear together with an adjustable frequency in the right ear that was defined for theta BB (since fc for theta EEG band was 4.60 Hz ± 0.70 SD) and beta BB (since fc for beta EEG band was 18.42 Hz ± 2.82 SD). The adjustable frequencies were estimated for each participant in accordance with their heart rate by applying the Brain-Body Coupling Theorem postulated by Klimesch. To achieve this aim, 20 healthy volunteers were stimulated with their personalized theta and beta BB for 20 min and their EEG signals were collected with 22 channels. EEG analysis was based on the comparison of power spectral density among three mental conditions: (1) theta BB stimulation, (2) beta BB stimulation, and (3) resting state. Results showed larger absolute power differences for both BB stimulation sessions than resting state on bilateral temporal and parietal regions. This power change seems to be related to auditory perception and sound location. However, no significant differences were found between theta and beta BB sessions when it was expected to achieve different brain entrainments, since theta and beta BB induce relaxation and readiness, respectively. In addition, relative power analysis (theta BB/resting state) revealed alpha band desynchronization in the parieto-occipital region when volunteers listened to theta BB, suggesting that participants felt uncomfortable. In conclusion, neural resynchronization was met with both personalized theta and beta BB, but no different mental conditions seemed to be achieved.

Clinical spectrum of pediatric drug refractory epilepsy secondary to parieto-occipital gliosis

BackgroundParieto-occipital (PO) gliosis secondary to perinatal insult, is often associated with neurologic sequelae such as epilepsy, which can be drug resistant. ObjectiveTo evaluate the spectrum of epilepsy among patients presenting with seizures in association with PO gliosis and to determine factors that influence the development of epileptic encephalopathy (EE) in these patients. MethodsWe retrospectively evaluated patients aged < 16 years with drug refractory epilepsy and PO gliosis who underwent video electroencephalography (Video EEG). We evaluated the clinical, electrophysiological and radiological profile including treatment responsiveness of subjects with EE. ResultsOne hundred one patients (M: F=3:1) with mean age of onset of epilepsy at 28.9 ± 33.1 months were recruited into the study. Based on video EEG findings, Based on video EEG findings, the commonest type of focal onset ictus was tonic seizures with impaired awareness (n = 26, 29.9%). Myoclonic jerks (n = 20, 23%) were the commonest type of generalised onset seizures. Ictal onset from parieto occipital region were observed in 28 patients. Ictal onset from frontal, temporal and fronto temporal region were observed in 6 (6.8%), 7(7.9%) and 9 (8.9%) patients, respectively. Comparison of the seizure types and ictal onset among subgroups of patients with occipital gliosis, parieto-occipital gliosis and parieto-occipital with frontal gliosis revealed that the extent of gliosis did not significantly affect seizure semiology or ictal onset. EE was significantly associated with presence of neonatal seizures (p = 0.04), hypoglycaemia (p = 0.005), longer duration of ICU stay (Z score = −3.55, p < 0.001) and younger age of onset of seizures (Z score = - 2.97, p = 0.03). Eleven out of eighteen (64.7%) subjects with EE showed greater than 50% improvement in seizure frequency following three months of pulse intravenous methylprednisolone therapy. ConclusionsAmong subjects with PO gliosis on MRI, the seizure semiology is unaffected by laterality, radiologic extension beyond the occipital cortex or presence of ulegyria. Patients with PO gliosis can have florid interictal epileptiform discharges anteriorly and can have seizures with ictal onset from frontal and temporal region. Development of EE is strongly related to the age of onset of seizures, neonatal seizures, prolonged NICU admission, rather than the radiological findings. Subjects with EE and PO gliosis show good response to intravenous pulse methylprednisolone.

Background Activity Findings in End-Stage Renal Disease With and Without Comorbid Diabetes: An Electroencephalogram Study.

Renal failure and diabetes can induce cerebral complications, including encephalopathy, for which attentional and cognitive impairment are common symptoms. It is possible that renal failure with comorbid diabetes may induce more severe encephalopathy due to multiple pathogenic mechanisms. This concept was supported by the main findings of this study, which showed that EEG background activity between end-stage renal disease with and without comorbid diabetes was significantly different in relative power of delta in the eyes-open condition in frontoparietal regions; theta in the eyes-closed condition in all regions; beta in the parieto-occipital regions in both eye conditions; the delta/theta ratio in both eye conditions in frontoparietal regions; and the theta/beta ratio in all regions in the eyes-closed condition. These findings may increase awareness of comorbid cerebral complications in clinical practice. Moreover, the delta/theta ratio is recommended as an optimal feature to possibly determine the severity of encephalopathy.

A Full-term Infant with Seizures.

A Full-term Infant with Seizures.

CEREBRAL AMYLOID ANGIOPATHY IN PREGNANCY: A CASE REPORT

TOPIC: Critical Care TYPE: Medical Student/Resident Case Reports INTRODUCTION: Cerebral Amyloid Angiopathy (CAA) is amyloid deposition within cerebral vessel walls which increases risk for spontaneous intracerebral hemorrhage (ICH) and occurs almost exclusively in patients over age 65. We report a young woman patient who presented for ICH with both imaging and tissue pathology consistent with CAA. CASE PRESENTATION: A 36-year-old G1P0 woman at 34 weeks gestation presented to the hospital after one day of severe headache. She denied recent trauma. Upon arrival the fetus was in distress prompting emergent delivered via cesarean section. The patient subsequently underwent CT head revealing an acute 6.3cm x 5.4cm x 3.1cm right parieto-occipital parenchymal hemorrhage and significant vasgoenic edema. Also noted, a concomitant subdural component to the hemorrhage, extending extra-axially up to 1 cm in diameter in the same right parieto-occipital region. There was resulting right-to-left midline shift, with the body of the right lateral ventricle nearly completely effaced. She was intubated due to developing encephalopathy and neurosurgery completed an urgent craniotomy. She initially improved and extubated three days later; however, four days after the procedure she developed recurrent right subdural hemorrhage with CT pertinent for further right-to-left midline shift with right lateral ventricular narrowing and new uncal deviation. She underwent middle meningeal artery embolization via interventional radiology to remove the source of the bleed. She recovered in the following days without complications and transferred out of the ICU. During the initial craniotomy, a tissue sample sent for pathology evaluation noted congophilic tissue consistent with CAA. DISCUSSION: While CAA can be presumed with CT or MRI imaging, it is optimally confirmed via tissue sample with Congo Red stain under polarized light microscopy. Epidemiologically, CAA strongly correlates with age thus rarely considered in women of childbearing age. There are few reports of CAA diagnosis in the pregnant population, likely due to misdiagnosis given other common pathologies such as gestational hypertension and preeclampsia which predispose patients to ICH. Additionally, invasive nature of confirming this pathology may play a role in misdiagnosis due to the risk of procedures in pregnancy. Mortality of CAA with ICH is 10-30% depending on location and size of the bleeding. Risk of recurrent bleeding is much higher than other causes of ICH. There is no currently agreed upon management of CAA. However, there is some evidence for the use of steroids and immunosuppressants to decrease CAA related vasogenic edema. It is also reasonable to suggest prevention of further hemorrhagic events with the avoidance of blood thinners. CONCLUSIONS: CAA should be considered in patients who present with ICH regardless of age or pregnancy. Confirmation with tissue biopsy is preferred for proper diagnosis and treatment. REFERENCE #1: Vinters, H. Cerebral amyloid angiopathy. A critical review. Stroke. 1987; 8(2):311-324. REFERENCE #2: Rosand, J. Muzikansky, A. Kumar, A. Wisco, JJ. Smith, EE. Betensky, RA. Greenberg, SM. Spatial clustering of hemorrhages in probable cerebral amyloid angiopathy. Ann Neurol. 2005;58(3):459. REFERENCE #3: Greenberg, S. Vonsattel J. Diagnosis of cerebral amyloid angiopathy. Sensitivity and specificity of cortical biopsy. Stroke. 1997;28(7):1418. DISCLOSURES: No relevant relationships by PARNEET DHALIWAL, source=Web Response No relevant relationships by Jessica Kent, source=Web Response No relevant relationships by Adan (Adam) Mora, source=Web Response No relevant relationships by Ciara Wisecup, source=Web Response

Cognitive and Affective Empathy in Huntington's Disease.

Empathy is a multidimensional construct and a key component of social cognition. In Huntington's disease (HD), little is known regarding the phenomenology and the neural correlates of cognitive and affective empathy, and regarding how empathic deficits interact with other behavioral and cognitive manifestations. To explore the cognitive and affective empathy disturbances and related behavioral and neural correlates in HD. Clinical and sociodemographic data were obtained from 36 healthy controls (HC) and 54 gene-mutation carriers (17 premanifest and 37 early-manifest HD). The Test of Cognitive and Affective Empathy (TECA) was used to characterize cognitive (CE) and affective empathy (AE), and to explore their associations with grey matter volume (GMV) and cortical thickness (Cth). Compared to HC, premanifest participants performed significantly worse in perspective taking (CE) and empathic distress (AE). In symptomatic participants, scores were significantly lower in almost all the TECA subscales. Several empathy subscales were associated with the severity of apathy, irritability, and cognitive deficits. CE was associated with GMV in thalamic, temporal, and occipital regions, and with Cth in parietal and temporal areas. AE was associated with GMV in the basal ganglia, limbic, occipital, and medial orbitofrontal regions, and with Cth in parieto-occipital areas. Cognitive and affective empathy deficits are detectable early, are more severe in symptomatic participants, and involve the disruption of several fronto-temporal, parieto-occipital, basal ganglia, and limbic regions. These deficits are associated with disease severity and contribute to several behavioral symptoms, facilitating the presentation of maladaptive patterns of social interaction.

Information Optimized Multilayer Network Representation of High Density Electroencephalogram Recordings.

High-density electroencephalography (hd-EEG) provides an accessible indirect method to record spatio-temporal brain activity with potential for disease diagnosis and monitoring. Due to their highly multidimensional nature, extracting useful information from hd-EEG recordings is a complex task. Network representations have been shown to provide an intuitive picture of the spatial connectivity underlying an electroencephalogram recording, although some information is lost in the projection. Here, we propose a method to construct multilayer network representations of hd-EEG recordings that maximize their information content and test it on sleep data recorded in individuals with mental health issues. We perform a series of statistical measurements on the multilayer networks obtained from patients and control subjects and detect significant differences between the groups in clustering coefficient, betwenness centrality, average shortest path length and parieto occipital edge presence. In particular, patients with a mood disorder display a increased edge presence in the parieto-occipital region with respect to healthy control subjects, indicating a highly correlated electrical activity in that region of the brain. We also show that multilayer networks at constant edge density perform better, since most network properties are correlated with the edge density itself which can act as a confounding factor. Our results show that it is possible to stratify patients through statistical measurements on a multilayer network representation of hd-EEG recordings. The analysis reveals that individuals with mental health issues display strongly correlated signals in the parieto-occipital region. Our methodology could be useful as a visualization and analysis tool for hd-EEG recordings in a variety of pathological conditions.

Two Different Neuroimaging Patterns in Two Cases with Eclampsia, HELLP syndrome and Posterior Reversible Encephalopathy Syndrome

Introduction: Preeclampsia (PE) and eclampsia are two clinical conditions associated with pregnancy. In eclampsia, seizures also occur. One of the complications of eclampsia is HELLP syndrome, a condition characterized by hemolytic anemia, elevated liver enzymes and thrombocytopenia. Preeclampsia and eclampsia are both well-known risk factors for posterior reversible encephalopathy syndrome (PRES), a clinical-radiological syndrome characterized by variable combinations of neurological signs. In this syndrome, typical neuroimaging findings are bilateral symmetric hemispheric edema in parietooccipital regions. However, atypical imaging findings have also been described. Here, we report two different neuroimaging patterns in two cases with PRES associated with eclampsia and HELLP syndrome. Case: Two pregnant female patients were admitted to our emergency department because of respiratory and neurological symptoms. While the medical history of one of the patients was unremarkable, the other patient was diagnosed with epilepsy and hypertension before pregnancy. Both of them had resistant increased blood pressure and seizures. They underwent urgent caesarean section. In the postoperative period, they were transferred into intensive care unit, necessitating mechanical ventilation because of respiratory failure. Laboratory findings were suggestive of eclampsia and HELLP syndrome and brain imaging findings were suggestive of PRES. Additionally, brain computed tomography scan of one of the patients showed subarachnoid haemorrhage and the magnetic resonance imaging scans of the other patient showed restricted diffusion, indicating cytotoxic edema. The patients were treated with blood transfusions and antihypertensive drugs. Maintenance of normotension resulted in neurological improvement. Subsequently, both of the patients were discharged without neurological sequela. Discussion and Conclusion: In this article, we reported both the associations between HELLP syndrome, eclampsia and PRES, and two different neuroimaging patterns of PRES. Effective controlling of blood pressure and treatment of HELLP syndrome resulted in complete disappearance of the radiological findings and improvement in the neurological sings.

Case Report: Giant Meningohydroencephalocele

BACKGROUND: Encephaloceles are a rare congenital anomaly, affecting 1 in 5 000 live births.A meningohydroencephalocele is the herniation of the meninges, ventricles, and part of the brain through a congenital defect in the skull. The prognosis of newborns depends on several factors. The young age and the associated congenital anomalies in these patients contribute to the diagnostic and treatment challenge. CASE REPORT: Male newborn, born at 37 weeks of gestation, by emergency C-section due to latent labor, presenting a large mass over the parieto-occipital region, with lobed, irregular edges, partially covered by the scalp, and in other areas a purplish red tone. The newborn was no very reactive, had decreased tone, absent crying. EVOLUTION: After specialist’s evaluation, due to the significant defect in the cranial shell and the structural brain abnormalities, the patient was not a candidate for surgical treatment. The newborn was discharged with a reduced life expectancy, to receive care at home. CONCLUSION: giant meningohydroencephalocele is a rare neural tube defect. The management of encephaloceles can be complicated and must be individualized, and will depend on the anatomical structures involved. Although in this case the prognosis was bad, multidisciplinary work is always necessary for proper management.

The functional indexes of RBCs and microcirculation in the traumatic brain injury with the action of 2-ethil-6-methil-3-hydroxypiridin succinate

Research aimTo study the RBCs functional and metabolic parameters and the microcirculatory brain structure at traumatic brain injury (TBI) under the action of 2-ethyl-6-methyl-3-hydroxypyridine succinate.MethodsA closed TBI was modeled by the free fall of a load on the parietooccipital regions of head. We made studies of the influence of 2-ethil-6-methil-3-hydroxipiridin succinate on aggregation and electrophoretic mobility of RBCs, catalase activity, malonic dialdehyde concentration, adenosine triphosphate and 2.3-biphosphoglycerate (2.3 – BPG) concentrations in RBCs. The state of parenchyma and microcirculatory brain mainstream in post-traumatic period of TBI have been studied on micro-preparations.ResultsThe use of 2-ethyl-6-methyl-3-hydroxypyridine succinate under conditions of head injury leads to a decrease in MDA concentration and in aggregation of RBCs, to an increase in the 2.3—BPG concentration and RBC electrophoretic mobility compared to the control (group value). The most pronounced changes under the action of 2-ethyl-6-methyl-3-hydroxypyridine succinate were observed 3–7 days after the TBI. Significant indicators of the restoration of the microvasculature and brain tissue provoked by the use of 2-ethyl-6-methyl-3-hydroxypyridine succinate of were evident from the 7th day unlike the control group, where the restoration of structural morphological parameters was observed only on the 12th day of the post-traumatic period. Fast recovery of blood flow under the action of 2-ethyl-6-methyl-3-hydroxypyridine succinate ensured effective restoration of neurons and glia in comparison with the control group.ConclusionsEarly and long-term cytoprotective correction intensifies the oxygen transport function of the blood, prevents and / or reduces disorders of microvessels, neurons and glia in the post-traumatic period, thereby provides correction of hypoxic state and drives to the restoration of brain tissues homeostasis.

Effects of dietary omega-3 intake on vigilant attention and resting-state functional connectivity in neurotypical children and adolescents

ABSTRACT Background: Vigilant Attention (VA) is a critical cognitive function allowing to maintain our attention, particularly in redundant or intellectually unchallenging situations. Evidence has shown that, as the brain develops, VA abilities rapidly improve throughout childhood and adolescence. Dietary omega-3 polyunsaturated fats (PUFA), playing a critical role for proper brain development and maturation of cortical regions, may contribute to variations in VA abilities. Objective: The present study investigated the effect of dietary omega-3 PUFA intake (docosahexaenoic acid (DHA) and eicosapentaenoic acid (EPA)) on resting-state functional connectivity (rsFC) of a meta-analytically defined VA network in 24 neurotypical children and adolescents (7.3–17.2 years) from the Healthy Brain Network databank. Methods: Functional MRI and phenotypical information were collected from the Healthy Brain Network databank. Intake of omega-3 DHA and EPA was assessed using a food frequency questionnaire and was adjusted for total calorie intake. Out of scanner VA-related performance was assessed using the VA condition of the Adaptive Cognitive Evaluation tool. Results: Overall, reported intake of omega-3 PUFA was not significantly associated with VA-related performance. Furthermore, energy-adjusted omega-3 intake was not significantly correlated with rsFC within the VA network. A complementary whole-brain analysis revealed that energy-adjusted omega-3 intake was correlated with decreased rsFC between parieto-occipital brain regions. Conclusion: The present study was not able to detect a relationship between dietary omega-3 and rsFC or VA performance.