Pressure Atrophy Research Articles

Evaluation of brain injury in goats naturally infected with Coenurus cerebralis; brain specific biomarkers, acute inflammation, and DNA oxidation

This investigate goals are to establish the utility of brain-specific biomarkers (GFAP and S100B) in vivo and to assess the brain damage in C. cerebralis-infected goats using histopathological and immunopathological methods. The animal material of the study consisted of 10 healthy and 20 Coenurus cerebralis infected female hair goats. Serum GFAP and S100B concentrations were measured to determine brain damage. Serum S100B (p < 0.037), GFAP (p < 0.012), urea (p < 0.045), GGT (p < 0.001) and ALT (p < 0.001) concentrations in the C.cerebralis group were significantly higher than the control group. There was no significant difference between the C.cerebralis group and the control group for hsTnI (p > 0.078), creatinine (p > 0.099) and CK-MB (p > 0.725). In the histopathological examination, pressure atrophy and related inflammatory changes were observed due to mechanical damage of the parasite. Immunohistochemical examinations revealed that the parasite stimulated inflammation with the expression of TNF-α and caused DNA damage with the expression of 8-OHdG. As a result, when the data collected for this study are assessed as a whole, it is thought that the use of brainspecific GFAP and S100B biomarkers may be beneficial in determining brain damage in naturally infected hair goats with C.cerebralis. Changes in the levels of brain-specific biomarkers contribute significantly to determining the prognosis of the disease in vivo. Measurement of GFAP and S100B concentrations from serum offers an important alternative to the CSF method.

Blood flow in the optic nerve head in patients with primary aldosteronism.

Optic nerve head (ONH) blood flow decrease without changes in intraocular pressure in a possible rat model of retinal ganglion cell loss by systemic administration of aldosterone. To compare the blood flow in the ONH, using laser speckle flowgraphy (LSFG), in healthy eyes and in eyes with primary aldosteronism (PA). The ONH tissue area mean blur rate (MT) was evaluated in this single center, retrospective, cross-sectional study using LSFG. In order to compare the MT between PA patients and normal subjects, mixed-effects models were used, with adjustments made for the mean arterial pressure, disc area, and β-peripapillary atrophy (β-PPA) area. Mixed-effects models were also used to analyze the risk factors affecting the MT. This study evaluated a total of 29 eyes of 17 PA patients and 61 eyes of 61 normal subjects. There was a significantly lower MT in PA patients (10.8 ± 0.4) as compared to the normal subjects (12.3 ± 0.3) (P = 0.004). The MT was significantly lower in PA patients (10.8 ± 0.6) even after adjusting for the potential confounding factors when compared to normal subjects (12.3 ± 0.3) (P = 0.046). Multivariate mixed-effects model analysis demonstrated that the MT was significantly associated with the PA and β-PPA. There was a significantly lower ONH blood flow in PA patients as compared to normal subjects.

Medical interventions for traumatic hyphema.

Medical interventions for traumatic hyphema.

Studies on endoparasitic copepods: Sarcotaces arcticus (Copepoda: Phylichthyid) infested dotted grouper (Epinephelus epilistictus) from the Arabian Gulf water, Saudi Arabia

This study aimed to investigate the presence of Sarcotaces sp. in Epinephelus epilistictus (the dotted grouper) in Saudi Arabia. So, during our routine clinical examination of fish health conditions at Jubail province in the eastern region of Saudi Arabia (Arabian Gulf), nine grouper fish species were examined for Sarcotaces sp. (Copepoda: Phylichthyidae). Only the dotted grouper (Epinephelus epilistictus) harbored parasitic Sarcotaces spp. with an incidence of 9.06% of 1600 clinically examined fish samples. The collected Sarcotaces sp. was Sarcotaces arcticus (S. arcticus). The copepods were completely encapsulated cysts with a pyriform or pear-like shape, small to large, white-grayish, fluid-filled with thick black ink beneath the skin, or fully embedded in the muscular layer. The cysts present in the lateral aspect of trunk muscles, flank, caudal peduncle, near the anal opening, or pelvic and pectoral fin with an infestation rate (1–6 cysts) per fish. The cyst histopathology reveals the capsular layer of the cyst consisting of fibrous connective with pressure atrophy of the adjacent muscles associated with dilated blood vessels. The absence of infestation in other kinds of grouper fish species from the water of the Arabian Gulf in Jubail province may indicate parasitic host specificity and geographic locality distribution.

Urinary calculi in larvae of striped trumpeter, Latris lineata.

Urinary calculi are observed in some cultured marine fish larvae and may negatively impact larval health and survival. This study assessed urinary calculi in striped trumpeter Latris lineata larvae from hatching to 28 days post-hatching (dph). The prevalence of urinary calculi was variable over time and ranged from 15% to 50%, whereas the average size of calculi increased with larval age. Urinary calculi were semi-translucent, light cream to white colour with irregular morphology and a uniform internal structure. The calculi resulted in pressure atrophy causing a distended epithelium of the urinary bladder of fish with calculi. The calculi were predominantly formed of calcium hydrogen phosphate (CaHPO4 ). Routine assessment of the prevalence of urinary calculi in marine fish larvae is recommended, along with other parameters, to monitor larval quality and inform hatchery management actions.

Voxel-based morphometry reveals altered gray matter volume related to cognitive dysfunctioning in neovascular glaucoma patients

We used correlation analysis to examine whether changes in grey matter volume in patients correlated with clinical presentation. gray matter volume was markedly reduced in neovascular glaucoma patients than healthy controls in the following brain regions: left cingulum anterior/medial frontal gyrus; left middle frontal gyrus, orbital part; left inferior frontal gyrus, orbital part; superior temporal gyrus/right frontal inferior orbital part. VBM directly suggests that neovascular glaucoma patients have changed in the volume of multiple brain regions. These changes exist in brain areas related to the visual pathway, as well as other brain areas which are not related to vision. The alteration of specific brain areas are closely related to clinical symptoms such as increased intraocular pressure and optic nerve atrophy in neovascular glaucoma patients. In conclusion, neovascular glaucoma may cause paralgesia, anxiety, and depression in patients.

Comparison of urinary protein-to-creatinine ration, serum albumin, serum creatinine and systolic arterial blood pressure of glomerular injury cases in dogs with chronic kidney disease

This study aims at assessing the prevalence of glomerular alterations in dogs with chronic kidney disease (CKD) and comparing the clinical and laboratory parameters. The tests conducted include a double-blind histopathological assay conducted by two pathologists, urine tests including inactive sediment, urinary protein-to-creatinine (UPC), serum albumin and serum creatinine, as well as measurement of the systolic arterial blood pressure. The prevalence of glomerular injuries was determined and the predominant injury was compared with a group comprised of the remaining injuries. The study included 24 dogs with CKD. The results revealed a predominance of membranous glomerular alterations 17/24 (70,83%), followed by glomerulosclerosis 3/24 (12,50%), membranoproliferative injuries 2/24, glomerulocystic atrophy 1/24 and glomerular amyloidosis 1/24. Amyloidosis presented the highest UPC while the membranoproliferative injury presented the lowest mean concentration of serum albumin. Higher values in the UPC did not correspond with lower mean serum albumin values. Glomerulosclerosis presented the highest mean systolic blood pressure and glomerular atrophy presented the highest creatinine values. When comparing membranous injuries with a group comprised of the remaining injuries, the UPC did not present significant differences between the groups. Renal amyloidosis was included in the group with the lowest systolic arterial blood pressure values while membranoproliferative injury was included in the group with highest UPC. The group called “others” presented the highest creatinine value. Dogs with CKD may present several types of glomerular injuries with similar clinical and laboratory profiles. This study observed a predominance of membranous glomerular injuries, followed by membranoproliferative injuries, glomerulocystic atrophy and amyloidosis.

Hemifacial spasm caused by a tortuous recurrent perforating artery: A case report

IntroductionWhen the culprit vessel in hemifacial spasm (HFS) is hard to determine, this is a challenge in microvascular decompression (MVD) surgery. In such a situation, small arteries such as perforators to the brainstem might be suspected. But small arteries are omnipresent near the facial nerve root exit/entry zone (fREZ). How to decide whether a given small artery is responsible for HFS is unclear. MethodWe report a case with a previously unreported form of neurovascular impingement, in which the culprit was found to be the recurrent perforating artery (RPA) from the anterior inferior cerebellar artery (AICA). An aberrant anatomic configuration of the RPA was found intraoperatively, which we thought was responsible for generating focal pressure on the facial nerve. Case reportA 62-year-old woman presented with a 1-year history of paroxysmal but increasingly frequent twitching in her right face. MRI showed tortuosity of the vertebral artery and apparently marked neurovascular impingement on the asymptomatic left side, while only the right AICA could be implicated as the possible culprit. Hemifacial spasm was diagnosed based on the typical clinical manifestation, and MVD was performed. The pre-meatal segment of the AICA was found not to be impinging the facial nerve at any susceptible portion near the fREZ: root exit point, attached segment, or root detachment point. The real culprit was in fact the RPA. This occult culprit vessel was tortuous, forming a coil-shaped twist which was interposed between the facial nerve and the intermediate nerve near the root detachment point. Focal pressure atrophy of the nerve was clearly observed at the compressing site. The patient achieved total spasm relief immediately after surgery, and remained spasm-free at 1-year follow-up, without any postoperative complications. ConclusionMVD is the only curative treatment for hemifacial spasm, but with a failure rate of around 10%. Mistaking the real culprit has been reported to be the most likely reason for surgical failure. Therefore, intraoperative identification of atypical occult forms of vascular compression is of importance to improve surgical outcome. In the present case, the RPA formed a coil-shaped twist, which inflicted focal vascular compression causing hemifacial spasm. We recommend careful inspection of the recurrent perforating artery during MVD for HFS, and decompressing any such neurovascular impingement.

Asymmetric diabetic retinopathy.

Increasing prevalence of diabetes mellitus warrants recognition of factors related to asymmetric diabetic retinopathy (DR). This thematic synthesis based on an iterative literature review conducted in Medline and Google Scholar pertaining to diabetes with coexistent asymmetry of retinopathy included 45 original articles, 21 case reports and series, and 18 review articles from 1965 to 2020. Asymmetric DR is defined as proliferative DR (PDR) in one eye and nonproliferative, preproliferative, background, or no DR in the other eye lasting for at least 2 years. It is observed in 5%–10% of patients with PDR. Associated factors can be divided into (i) vascular: carotid obstructive disease, ocular ischemic syndrome, and retinal vascular diseases; (ii) Inflammatory: uveitis, endophthalmitis, and Fuchs’ heterochromic cyclitis; (iii) degenerative: posterior vitreous detachment, high myopia and anisometropia, uveal coloboma, retinal detachment, retinitis pigmentosa, and chorioretinal atrophy and scarring; (iv) cataract surgery and vitrectomy; and (v) miscellaneous: elevated intraocular pressure, glaucoma, amblyopia, retinal detachment, and optic atrophy. The gamut of diagnostic modalities for asymmetric DR includes thorough ocular examination, slit-lamp biomicroscopy, fundus photography, fundus fluorescein angiography, optical coherence tomography, and newer modalities such as ultra-widefield fluorescein angiography and optical coherence tomography angiography, along with a complete systemic evaluation and carotid Doppler studies. The differential diagnosis includes other causes of retinal neovascularization that may present in an asymmetric manner, such as sickle cell retinopathy, retinal vein occlusions, and featureless retina. This review discusses in detail the aforementioned considerations and draws a comprehensive picture of asymmetric DR in order to sensitize ophthalmologists to this important condition.

Surgical Treatment of Monostotic Craino-Facial Fibrous Dysplasia: Changing the Narratives

Background: Fibrous dysplasia mainly presents in its monostotic form in the cranio-facial region with serious cosmetic disfigurement and functional derangement of the affected and adjacent structures putting both patient and the attending surgeon in great dilemma. Surgical treatment is the only rewarding and generally accepted treatment option, however, controversy over the surgical technique to be adopted still exists. While in the past, surgeons generally adopted conservative shaving or contouring technique, over the recent years, advocates of radical surgery are winning more disciples. Objective: To highlight the locally destructive, functionally degrading nature of a neglected or poorly excised (shaved) lesion in patients and highlight the outcome of total excision and surgical technique adopted to obviate the need for autologous bone grafting and two-staged surgery. Subjects and Method: We present case series of three patients with giant monostotic fibrous dysplasia of the maxilla, surgically treated in our Centre, who were part of a total of eight cases managed over the past fifteen years in our department of Ear, Nose and Throat-Head and Neck Surgery. The pre-operative clinical assessment, relevant investigations and post-operative outcome are presented. Our surgical technique is highlighted. All the patients had unilateral lesion of the maxilla with gross cosmetic and functional defects. Two of the patients had ischaemic (pressure) atrophy of the cheek soft tissue and skin leading to skin metaplastic changes including leukoplakia, hyperpigmentation. Post-operative follow-up showed satisfactory cosmetic outcome and significant reversal of malocclusion and dental anarchy. There was no recorded recurrence throughout the follow-up period ranging from four to eleven years. Nasal airway was re-established bilaterally in all the cases. Conclusion: Total or near total excision surgical technique with periosteal preservation is our treatment of choice in the management of monostotic cranio-facial fibrous dysplasia. Given the fact that the growth of the tumours often does not cease after puberty against general belief, shaving or contouring technique should be relegated to the background. Our technique of no grafting which reduced cost and morbidity to the patient should be encouraged.

Obstructive Urolithiasis In Dromedary Camels: Clinical, Ultrasonographic And Postmortem Findings

This article was written to evaluate camels with obstructive urolithiasis with special reference to the clinical, ultrasonographic and postmortem findings. Twenty male camels (Camelus dromedarius) with urolithiasis were examined. Of them, 18 had ruptured bladder and 2 had ruptured urethra. Main clinical findings included depression, anorexia and anuria. Ventral abdominal swelling was also detected in front of the penis with swelling of the prepuce. Exploratory laparotomy showed a massive amount of reddish uroperitoneum. In the camels with ruptured urethra, penile and ventral edema was detected in front of the penis with swelling of the prepuce. The urine penetrated the adjacent tissues that also yielded dark red urine on aspiration. The most important ultrasonographic findings included a collapsed urinary bladder in animals with ruptured bladder. Uroperitoneum was imaged easily where viscera were seen floating in the urine. Dilatation of the pelvic and penile urethra as a result of calculi was detected by ultrasonography. The urinary bladder wall was intact in cases before bladder perforation. Hydronephrosis with parenchymal pressure atrophy was also detected. The obstructing calculus was also seen within the penile urethra as a hyperechoic mass with distal acoustic shadowing. The perforated urinary bladder was also seen. In cases with ruptured urethra, the bladder wall was imaged intact and it contained hyperechoic sediment. Postmortem examination confirmed the ultrasonographic findings.

Spinal stabilisation using a polyvinilidine (Lubra) plate in a pot-bellied pig

A three-month-old pot-bellied pig presented for acute paraplegia following a presumptive fall. CT examination identified a vertebral subluxation of L1–L2 with a comminuted fracture of the L1 vertebra. Spinal stabilisation...

Tracking down the White Plague: The skeletal evidence of tuberculous meningitis in the Robert J. Terry Anatomical Skeletal Collection.

Paleopathological diagnosis of tuberculosis (TB) essentially relies on the identification of macroscopic lesions in the skeleton that can be related to different manifestations of TB. Among these alterations, granular impressions (GIs) on the inner skull surface have been considered as pathognomonic features of tuberculous meningitis (TBM). GIs may be established by pressure atrophy of the tubercles formed on the outermost meningeal layer during later stages of TBM. Although GIs were used as diagnostic criteria for TBM in the paleopathological practice since the late 20th century, their diagnostic value has been questioned. To contribute to strengthening the diagnostic value of GIs, a macroscopic investigation-focusing on the macromorphological characteristics and frequency of GIs-was performed on skeletons of known cause of death from the Terry Collection. The χ2 analysis of our data revealed that GIs were significantly more common in individuals who died of TB than in individuals who died of non-TB causes. Furthermore, GIs were localized on the inner surface of the skull base and of the lower lateral skull vault. The localization pattern and distribution of GIs on the endocranial surface resemble that of the tubercles observed in the affected meninges during the pathogenesis of TBM. Our results strengthen the tuberculous origin of GIs and imply that they can be considered as specific signs of TBM. Therefore, GIs can be used as diagnostic criteria for TBM in the paleopathological practice, and the diagnosis of TBM can be established with a high certainty when GIs are present in ancient human bone remains.

Frequency and morphology of benign histopathological lesions in total abdominal hysterectomy specimens.

Hysterectomy is one of the most frequently performed gynecological procedure all over the globe undertaken for varying indications, to effectively cure many gynaecological conditions. Histopathological analysis of the hysterectomy specimens should be undertaken for justification of procedure and diagnostic purposes. Objectives: To determine the frequency and morphology of different benign histopathological lesions in total abdominal hysterectomy specimens. Study Design: Descriptive cross-sectional study. Setting: Department of Pathology Fatima Jinnah Medical College. Period: From Jan 2015 to June 2015. Material &amp; Methods: The gross and histopathological findings of uterus and cervix in one hundred Total Abdominal hysterectomy specimens were studied. Non-probability, purposive sampling was done. Total abdominal hysterectomy specimens with or without salpingoophorectomy of patients aged between 20 to 70 years were included. While Total abdominal hysterectomy done in mentally retarded patients and for malignancies were excluded. Patient’s data, presenting complaints and preoperative diagnosis was recorded on predesigned proforma. SPSS version 17 was used as an analytical tool. Results: Age of the patients ranged from 30-55 years with 72% between 41-50 years. The microscopic examination of the cervix revealed features of chronic cervicitis in 75% cases. The commonest neoplastic lesion was leiomyoma present in 66% of cases. Myometrium revealed foci of adenomyosis in 21% cases. Endometrial histology showed hyperplasia in 25% of cases(simple hyperplasia 20%, cystic hyperplasia 4% and complex hyperplasia 1%), hormonal imbalance in 21%, pressure atrophy in 11%, atrophic endometrium in 6% , cystic atrophy in 2% while acute and chronic endometritis in 1% and 2% of cases respectively. Conclusion: The commonest cervical lesion was chronic cervicitis (75%). The commonest benign neoplastic lesion was leiomyoma, present in 66% of cases. Other common pathologies on histology were hyperplasia in 25% of cases, adenomyosis and hormonal imbalance in 21 % of cases each, pressure atrophy in 11%, atrophic endometrium in 6% while endometritis (acute &amp; chronic ) in 3% of cases mainly. Histopathological examination of hysterectomy specimens helps to detect the exact cause and underlined pathology.

Painful Pressure Atrophy of the Skull Following Epicranial Cable Placement in Deep Brain Stimulation: a Case Report

As a growing number of centers worldwide perform deep brain stimulation as a standard procedure, many authors have analyzed its characteristic hardware-related problems. Here, we demonstrate a case of hardware-related painful bone atrophy that highlights the importance of careful cable placement. A 68-year-old female patient with an implanted DBS system presents with pain of the mediosagittal cranial aspect of the head. Upon removal of the DBS system, pressure atrophy of the skull is observed below a compacted cable loop. Postoperatively, the patient reported full alleviation of the pressure sensation and pain.

Cytomegalovirus Associated Uveitis; Clinic, Diagnosis and Treatment

Cytomegalovirus is a double-stranded DNA virus in the herpesviridae family and a widespread pathogen in the general population. It causes both anterior and posterior uveitis in immunocompetent and immunocompromised individuals. While anterior uveitis is characterized by high intraocular pressure and iris atrophy; retinitis and rarely acute retinal necrosis are the clinical presentations in posterior uveitis.

The parasitic isopod Mothocya nana drives dietary shifts and poorer condition of Brazilian silversides Atherinella brasiliensis.

Cymothoids are ectoparasites that may attach to various parts of the fish for molting and reproductive purposes, thus increasing the energetic costs of the host. This study investigated the influence of the parasitic isopod Mothocya nana on the physiological condition and diet of adult Brazilian silversides Atherinella brasiliensis at a sandy beach in southeastern Brazil. We collected 268 A. brasiliensis individuals, of which 230 fish were non-parasitized (mean ± SE total weight [TW] = 16.92 ± 0.38 g; total length [TL] = 127 ± 0.88 mm) and 38 were parasitized by up to 2 isopods (TW = 15.89 ± 0.79 g; TL = 126 ± 1.96 mm). Parasitic prevalence (P) and intensity (I) reached highest values in June 2015 (P = 20.88%; I = 1.31) and were slightly higher on males (P = 17.39%; I = 1.33) than on females (P = 13.07%; I = 1.27). Parasitized fish revealed poorer condition than non-parasitized ones, among which male hosts were especially burdened by M. nana's attachment. The condition factor, the eviscerated condition factor and the fullness index each showed a decreasing trend according to the parasite's development and offspring weight (i.e. increase in egg and larval weight). Parasitized and non-parasitized Brazilian silversides fed mainly on microcrustaceans, but the first group showed reduced phytoplankton intake and was associated with fewer trophic categories in comparison to non-parasitized fish. These dietary shifts revealed correlation with the poorer physiological condition reported for infected A. brasiliensis, whose decreased feeding efficiency is likely related to potential impairment of the filter-feeding mechanism and/or altered behaviour due to pressure atrophy and the increased energetic costs imposed by M. nana's development.

Rare Case of Intestinal Lipomatosis Presenting With Hemorrhage

Introduction Diffuse intestinal lipomatosis is a very rare disease characterized by multifocal infiltration of mature adipose tissue into the intestinal submucosal or subserosal layers. The disease is mostly asymptomatic but complications like intussusceptions, obstruction, bleeding or perforation have been reported. Gastrointestinal (GI) lipomas occur in colon, small bowel, stomach and esophagus in decreasing frequency. Lipomas >2cm size are more prone to having complications. We here in describe a very rare care of diffuse intestinal lipomatosis presenting with hemorrhage. Case Report A 59-year-old Caucasian woman with hypothyroidism presented with worsening shortness of breath and dark stools for few days. Physical exam was remarkable for mucosal pallor. Laboratory studies showed severe anemia with hemoglobin of 4.7 gm/dL. Diagnostic upper endoscopy showed a large friable mass with overlying small old clot in second portion of duodenum (D2) adjacent to the ampulla. There were multiple other submucosal mass lesions in the entire examined small bowel. Colonoscopy also showed multiple (˜20) submucosal lesions throughout the colon suggestive of likely diffuse intestinal lipomatosis. Endoscopic ultrasound (EUS) done for elucidation of nature of D2 lesion revealed an oval hyperechoic lesion measuring 39×24mm arising from the submucosal layer without involving muscularis propria. Fine needle biopsy of the lesion revealed adipocytes. Discussion Solitary lipomas of GI tract are common accounting up to 8% of all GI tumors. However GI lipomatosis is very rare with an incidence of 0.04%. It's etiopathogenesis is unclear. Anomalies in embryonic development, fat dysmetabolism, chronic inflammation, alcohol use and hamartomatous syndromes have been implicated. Ileum is the most common site of enteric lipomas (25% of all GI tract lipomas) with duodenum being least frequent (4%). Endoscopic signs suggestive of lipomas include: tenting sign, cushion sign and the ‘naked fat’ sign (fat protruding from the biopsy site). A lipoma rarely can present with overt GI bleeding from apical ulceration. Ulceration results from pressure atrophy of mucosa and necrosis of the overlying epithelial layers due to abnormal peristalsis. Ulceration can be extensive with profuse bleeding requiring aggressive endoscopic, radiological or surgical management. Endoscopic modalities of managment include snare / endoloop resection and submucosal dissection.1870_A Figure 1. Multiple rounded submucosal lesions in the small bowel with positive cushion sign consistent with lipomas (A); large submucosal mass lesion in D2 adjacent to the ampulla (B).1870_B Figure 2. EUS showing an oval hyperechoic, heterogenous lesion measuring arising from the submucosal layer1870_C Figure 3. Fine needle biopsy showing adipocytes and mucosal epithelial cells

Total Small Vessel Disease Score in Neurologically Healthy Japanese Adults in the Kashima Scan Study.

Objective We explored the association between the total small vessel disease (SVD) score obtained with magnetic resonance imaging and risk factors and outcomes in the Japanese population. Methods The presence of SVD features, including lacunes, cerebral microbleeds, white matter changes, and basal ganglia perivascular spaces on MRI, was summed to obtain a “total SVD score” (range 0-4). Ordinal and multinomial logistic regression analyses were performed to investigate the association of higher total SVD scores with vascular risk factors, the Mini-Mental State Examination (MMSE) score, and cerebral atrophy. Results We included 1,451 neurologically healthy adults (mean age, 57.1 years; 47% male). A multivariate ordinal logistic regression analysis showed that the total SVD score was associated with aging, hypertension, blood pressure (BP), diabetes mellitus, MMSE score, and deep cerebral atrophy, but the equal slopes assumption between scores did not hold. A multivariate multinomial logistic regression analysis (total SVD score 0=reference) showed that aging, hypertension, and BP were positively associated with scores of 1, 2, or ≥3. These effects, presented as odds ratios (ORs), increased as the score increased and were strongest with a score of ≥3 [aging (per 10-year increment), OR 4.00, 95% confidence interval (CI) 2.47-6.46; hypertension, OR 5.68, 95% CI 2.52-12.80; systolic BP (per standard deviation increase), OR 1.96, 95% CI 1.41-2.74, respectively]. Diabetes mellitus and deep cerebral atrophy tended to be associated with the SVD scores. The MMSE score showed no consistent associations. Conclusion The total SVD score may be a promising tool for indexing SVD, even in the Japanese population.

Low grade astrocytoma causing dural and calvarial destruction

This case report describes destruction of overlying dura and calvaria by a low grade glioma in the absence of prior surgery or radiation. Bone and dural involving is known to occur with some malignant tumors, but due to low grade glioma is very rare.The initial radiologic examinations demonstrated a heterogeneous mass in the right parietal region with both extra- and intra-axial components. No inward displacement of the adjacent dura was observed. Initial consideration for extra-axial lesions includes metastatic lesions, lymphoma, or an aggressive meningioma. The pathologic findings demonstrated a glial cell origin.To our knowledge, destruction of the dura and calvaria from a low-grade glioma, without prior surgery or radiation, has not been well documented previously. Calvarial destruction with associated intra-axial lesions on imaging may prompt the diagnosis of extra-axial tumors such as aggressive meningiomas, metastasis and lymphoma.We report an unusual case of parietal low-grade glioma with destruction of the dura and calvaria in the absence of prior surgery or radiation. The erosion probably is due to pressure atrophy of the dura and inner table and thinning of the diploe.The mechanism of skull erosion in these superficial gliomas relates to their chronic mass effect (8). The mass displaces the CSF, which normally cushions and diffuses brain pulsations over a wide area. Once the CSF space is effaced, the brain may directly transmit these pulsations to the inner table. Over time, this localized elevated pressure may erode the cortical bone of the inner table.