Severe Neurological Deficits Research Articles

КОГНИТИВНЫЙ И НЕВРОЛОГИЧЕСКИЙ СТАТУС КРЫС ПОСЛЕ МОДЕЛИРОВАНИЯ ОСТРОЙ ЧЕРЕПНО-МОЗГОВОЙ ТРАВМЫ НА ФОНЕ ПРИМЕНЕНИЯ РАЗЛИЧНЫХ КОНЦЕНТРАЦИЙ КСЕНОНА

The study aims to evaluate the efficacy of xenon inhalation at various concentrations on neurological and cognitive impairments when simulating open traumatic brain injury (TBI) in rats. Tests were performed on 35 male Wistar rats weighing from 250 to 350 g. After simulating an open traumatic brain injury, the animals received inhalation with a mixture of gases: 5 sham operated animals received only anesthesia without traumatic brain injury and inhalations, a control group with traumatic brain injury + inhalation N2 70 % / O2 30 % (group “TBI”, n = 10); an experimental group with traumatic brain injury + inhalation of xenon-oxygen 70 % / O2 30 % (group “TBI + iXe70”, n = 10), an experimental group with traumatic brain injury + inhalation of xenon-oxygen and nitrogen – Xe 35 % / O2 30 %, nitrogen 35 % (group “TBI + iXe + N2”, n = 10) for 60 minutes. After gas inhalation, the animals were observed for 14 days. On the 3rd, 7th and 14th days, the neurological limb placement test was carried out. The preservation of cognitive functions, such as learning and spatial memory, was assessed using the Morris water maze test with control testing on the 14th day. After testing, on the 14th day of observation, euthanasia was performed, and the brain was collected for research. It was found that the selected xenon concentrations in doses of 0.25 and 0.5 MAC tatistically significantly reduced the severity of both neurological deficit and cognitive impairment in 7 and 14 days, whereas increasing the xenon concentration did not significantly enhance the neuroprotective effect.

GM1 and GM2-Gangliosidosis: Clinical Features, Neuroimaging Findings and Electroencephalography.

Gangliosidosis is one of the hereditary metabolic diseases caused by the accumulation of Gangliosid in the central nervous system, leading to severe and progressive neurological deficits. Regarding phenotype, GM1 and GM2-Gangliosidosis are divided into Infantile, Juvenile, and Adult. In this study, thirty-seven patients with GM1 and GM2-Gangliosidosis were referred to the neurology department of Mofid Children's Hospital in Tehran, Iran, whose disease was confirmed from September 2019 to December 2021. This study assessed age, sex, and developmental status before the onset of the disease, clinical manifestations, brain imaging, and electroencephalography. 97.20% of patients were the result of family marriage. Approximately 80% of juvenile patients were developmentally normal before the onset of the disease. Developmental delay was more common among infantile GM1-Gangliosidosis than infantile GM2-Gangliosidosis, but in total, more than 50% of GM1&GM2-Gangliosidosis patients had reached their developmental milestone before the onset of the disease. With the onset of disease symptoms, 100% of patients regressed in terms of movement, 97.20% of them mentally, and 75% of them had seizures during the disease. The most common clinical findings were cherry-red spot, Mongolian spot, macrocephaly, organomegaly, hyperacusis, and scoliosis. The most common brain imaging findings included bilateral thalamus involvement, brain atrophy, PVL, and delayed myelination. The most common finding in electroencephalography was background low voltage with abnormal sharp waves. This study concluded that most of the patients are the result of family marriage, and most of the juvenile patients are developmentally normal before the onset of the disease. In addition, more than 50% of infantile patients reach their developmental milestones before the onset of the disease. The most common clinical findings of these patients are seizures, cherry-red spot, macrocephaly, hyperacusis, Mongolian spot, and bilateral involvement of the thalamus.

Ossification of Cranial Epidural Hematomas: A Systematic Review of Management Strategies and Presentation of an Illustrative Case.

The presence of a calcified or ossified chronic cranial epidural hematoma (EDH) is rare and has been described in only a few case reports in the literature. Consequently, clear treatment strategies remain elusive and may entail conservative and surgical approaches. In this study, we performed a systematic review of reported cases to evaluate the clinical course and treatment options for these patients. A comprehensive systematic search of two databases was performed, and information on patient characteristics, symptomatology, and treatment was extracted from eligible articles. A total of 56 cases were included in our analyses. Forty patients were male, 16 were female, with an average age of 21.38 years at the time of diagnosis. Assumed etiology was previous trauma in 35 cases, previous cranial surgery in 17 patients, and birth trauma and epidural bleeding after the utilization of the Mayfield clamp in 1 case each. The origin remained unclear in two cases. The time between trauma or surgery and diagnostics ranged between one and a half weeks and 50 years, with a median of 4 years (SD 9.8 years). The symptoms were very heterogeneous, ranging from acute neurological deterioration to chronic symptoms. In 15 cases, patients were asymptomatic, and cranial imaging was performed as part of a new trauma or a screening for other disease. Forty-one patients received surgical treatment by craniotomy and hematoma evacuation, and 13 patients were treated conservatively. In two cases, the liquid hematoma portion was aspirated through a burr hole. The localization of calcified or ossified EDH was mainly supratentorial. Young male patients most commonly present with calcified or ossified EDH after trauma, according to the epidemiological trend of acute EDH. Clinical presentation varies from asymptomatic to severe neurological deficits and signs of increased intracranial pressure. There is no standardized treatment; decisions must be made on an individual basis.

Masson’s tumor of the thoracic spine: A rare cause of slowly progressive paraplegia

Introduction. Intravascular papillary endothelial hyperplasia is an unusual reactive proliferation of endothelial cells around an organized thrombus, which occurs either in a dilated blood vessel, hematoma, or preexisting vascular lesion. These tumors rarely affect the central nervous system. Symptoms depend on the localization of the process itself. Localization in the central nervous system is limited to the intracranial space. Localization in the spinal canal is extremely rare, and only a few clinical cases have been described so far in the literature. Case report. A 67- year-old female patient was examined neurologically initially due to bilateral weakness of the lower extremities, accompanied by a feeling of pain and muscle tension, dominantly in the upper legs, more to the right. The complaints were present a year ago, and before that period, the patient was in a stable state of health. Due to a severe neurological deficit and the need for detailed exploration, the patient was hospitalized. A diagnosis was performed, which showed the localization of the pathological process in the thoracic 5?6 region of the spinal column. Decompression surgery was performed, and with the ex tempore findings metastasis was ruled out. Definitive pathohistological findings proved Masson?s tumor. After the operation, the neurological weakness recovered. Conclusion. Masson?s tumor, although rarely localized in spinal canal, is curable if it is correctly diagnosed and if an adequate therapeutic approach is applied. The initially presented symptoms may resemble numerous neurological or systemic diseases, which requires the clinician to be continuously aware of such rare pathological processes.

On the issue of optimizing protein and energy supply for patients with acute cerebrovascular accident

To study the severity of systemic metabolic dysfunction in various types of stroke and determine the parameters of optimal energy and protein supply for this category of patients in the presence of severe neurological deficit (National Institutes of Health Stroke Scale - NIHSS score of 15 points or more) during different periods of the disease. The retrospective study included 512 patients with acute cerebrovascular accident (ACVA) who received nutritional support (NS) for 10 days or more: 367 (71.7%) people with ischemic stroke (IS) and 145 (28.3%) - with hemorrhagic stroke (HS). The course of stroke in all patients included in the study was accompanied by severe and extremely severe neurological disorders (15 points or more on the NIHSS scale). Energy expenditure and the severity of the catabolic reaction of the body were studied by dynamic assessment of indirect calorimetry indicators and actual nitrogen losses. More than 99% of patients received tube feeding. Using the method of indirect calorimetry, the ranges of energy expenditure during stroke were determined: for IS - 1600-2100 kcal/day (24-26 kcal/kg/day), for HS - 1900-2600 kcal/day (26-30 kcal/kg/day) in depending on the period of the disease. The average nitrogen losses at all stages of the disease in patients with IS and HS were comparable. In IS, these amounts were 19 g/day (0.25 g/kg/day), which corresponds to 119 g/day of protein (1.56 g/kg/day of protein), and in HS patients lost an average of 18.9 g/day of nitrogen (0.24 g/kg/day) or 118 g/day of protein (1.5 g/kg/day of protein). The maximum nitrogen losses were observed in the period from 10 to 20 days of illness and amounted to 24.7 g/day in patients with HS (0.31 g/kg/day or 1.93 g/kg/day protein), and in patients with IS - 24.5 g/day (0.29 g/kg/day or 1.81 g/kg/day protein). An identified trend towards a decrease in mortality in patients with acute stroke with energy supply in the amount of 27-28 kcal/kg/day and protein consumption in the amount of 1.3-1.4 g/kg/day compared with patients receiving 20-21 kcal/kg /day and 1-1.2 g/kg/day of protein requires further prospective randomized studies.

ЭНЦЕФАЛОПАТИЯ ВЕРНИКЕ ПОСЛЕ БАРИАТРИЧЕСКОЙ ОПЕРАЦИИ: СЛУЧАЙ ИЗ ПРАКТИКИ

Objective: To review the signs and symptoms of Wernicke encephalopathy (WE) after bariatric surgery based on 2 case reports and a literature data analysis. Methods: We present two case reports of WE. In these patients, thiamine deficiency developed due to bariatric gastric surgery, which was performed to treat class III obesity, formerly known as morbid obesity. The patients underwent comprehensive physical and neurological examinations; clinical, laboratory, and instrumental data were collected from medical records and analyzed. The researchers also performed a computerized search using the keywords "Wernicke encephalopathy after bariatric surgery" to find relevant publications in the PubMed/Medline, Scopus, and Web of Science databases. Results: The presented acute neurological condition related to vitamin B1 deficiency in two patients after undergoing a weight loss surgery, specifically a mini-gastric bypass. The clinical picture in one patient was dominated by memory impairment, ataxic, and polyneuritic syndrome, while in the other, it was only polyneuritic syndrome. Conclusion: The initial symptoms of WE are often overlooked, leading to the progression of the disease with the development of severe neurological deficits. To prevent the progression of encephalopathy, it is necessary to begin treatment with high doses of parenteral thiamine replacement therapy as early as possible. Keywords: Obesity, bariatric surgery, Wernicke encephalopathy, thiamine, case report

Sensorimotor Rehabilitation and Psychotherapeutic Techniques Effect on the Psychoemotional State in the Stroke Recovery Period

INTRODUCTION. Stroke is the leading cause of disability of the population. In addition to motor disorders, cognitive and affective disorders contribute to the development of disability. The development of effective neurorehabilitation programs aimed not only at reducing the severity of motor deficits, but also at timely correction of psychoemotional disorders in stroke patients is very relevant for restorative medicine. In view of the proven positive therapeutic effect of physical exercises on anxiety and depression, their protective effect on cognitive functions, it is of interest to study the effect of motor rehabilitation on psychoemotional disorders in stroke patients.
 AIM. To study the effect of sensorimotor rehabilitation on affective and cognitive disorders in patients in the recovery period of stroke in comparison with a complex psychotherapeutic technique.
 MATERIALS AND METHODS. The study examined 2 groups of patients in the recovery period of ischemic stroke (up to 2 years) with the presence of anxiety and/or depressive disorders, comparable in gender, age, duration and focus of stroke localization, severity of neurological deficit. The 1st group — 24 patients — received a course of sensorimotor rehabilitation without targeted impact on affective disorders; the 2nd group — 25 patients — a course of complex medical and psychological adaptation lasting 18 days. The effectiveness of rehabilitation was assessed using validated scales and questionnaires (Rivermead Mobility Index, 6-point muscle strength assessment scale, modified Ashfort spasticity scale; Berg balance scales, Beck depression, Spielberger-Khanin anxiety, MMSE, MoCA; Schulte Table Methodology, SS-QOL Stroke Quality of Life Assessment Scale). Statistical analysis was carried out using the StatTech v. 2.8.8 program (developed by Stattech LLC, Russia).
 RESULTS AND DISCUSSION. The preliminary assessment carried out in both groups showed a twofold predominance of anxiety states over depressive ones, concomitant cognitive impairments were detected in 88 % of patients, among whom attention disorders were most often recorded (there was no intergroup difference in these indicators). After completing the course of both sensorimotor and medico-psychological rehabilitation, both groups showed a significant decrease in the level of situational and personal anxiety on the Spielberger-Khanin scale, positive dynamics on the MoСа scale, the SS-QOL questionnaire, while a significant decrease in the level of depression on the Beck scale was registered only in patients of the 2nd group on against the background of the use of specialized psychotherapeutic techniques.
 CONCLUSION. Motor rehabilitation is positively comparable with complex medical and psychological adaptation, it affects anxiety and cognitive functions in patients with ischemic stroke, it can be considered as one of the effective ways to correct anxiety states and prevent cognitive impairment in these patients, while in the treatment of depression the priority is should be given to specialized medical and psychological intervention.

A rare anatomical variation of the circle of Willis in a patient with an ischemic stroke

Purpose 
 The cerebral arterial circuit provides collateral circulation to the brain and protects the brain from ischemia, by sustaining tissue perfusion in case of reduced or impaired blood flow through its branches. Although many random anatomical variations in the circle of Willis (CoW) are of minor importance, some increase the risk of ischemic events, aneurysm, and atherosclerosis, and play an important role in endovascular and surgical treatment planning. 
 Case presentation 
 We report a rare arterial variation of the CoW diagnosed by computed tomography angiography in a patient with ischemic stroke. We found aplasia of the A1 segment of the left anterior cerebral artery and ipsilateral hypoplasia of the P1 segment of the left posterior cerebral artery. 
 Conclusion 
 For neurosurgeons, neurologists, and neuroradiologists, detailed knowledge of the numerous anatomical variations in the arterial supply to the brain is crucial to make a correct diagnosis and choose the appropriate treatment. The type of CoW variation influences stroke severity and outcome, with an incomplete CoW related to more severe conditions (higher National Institutes of Health Stroke Scale scores, more severe neurological deficits, and worse neurological outcomes) and poor prognosis.

Stroke as the index presentation of traditional cardiovascular risk factors and Human Immunodeficiency Virus in a South African population

ObjectivesWe sought to identify what proportion of each cardiovascular risk factor and Human Immunodeficiency Virus (HIV) was first diagnosed at the time of stroke, compared to those that were diagnosed prior to the event, and to explore if this had any impact on the severity of stroke. MethodsAdult patients presenting with a new stroke to a quaternary hospital in Johannesburg between 2014 and 2017 were prospectively recruited. Patients were investigated for undiagnosed traditional cardiovascular risk factors (hypertension, diabetes mellitus, dyslipidaemia, atrial fibrillation, obesity and smoking), as well as HIV infection. Stroke severity was assessed using the National Institutes of Health Stroke Scale (NIHSS). Results346 patients were included. Stroke was the index presentation for at least one risk factor in 199 (57.5 %) patients. Dyslipidaemia was newly diagnosed in 76.0 % of all dyslipidaemics (95 out of 125). Newly-diagnosed dyslipidaemia was associated with a more severe neurological deficit (Median NIHSS of 12 (8-16) vs 7 (4-12), p=0.0007) and younger age on presentation (53 (44-63) years vs 62 (51-71) years, p=0.02) as compared to previously-diagnosed dyslipidaemia. ConclusionsMore than half of patients had previously undiagnosed modifiable risk factors at the time of their stroke. Dyslipidaemia was undiagnosed in a very high proportion, and this was associated with a higher stroke severity and younger age of presentation.

IL-10 protects against OPC ferroptosis by regulating lipid reactive oxygen species levels post stroke

Accumulation of reactive oxygen species (ROS), especially on lipids, induces massive cell death in neurons and oligodendrocyte progenitor cells (OPCs) and causes severe neurologic deficits post stroke. While small compounds, such as deferoxamine, lipostatin-1, and ferrostatin-1, have been shown to be effective in reducing lipid ROS, the mechanisms by which endogenously protective molecules act against lipid ROS accumulation and subsequent cell death are still unclear, especially in OPCs, which are critical for maintaining white matter integrity and improving long-term outcomes after stroke. Here, using mouse primary OPC cultures, we demonstrate that interleukin-10 (IL-10), a cytokine playing roles in reducing neuroinflammation and promoting hematoma clearance, significantly reduced hemorrhage-induced lipid ROS accumulation and subsequent ferroptosis in OPCs. Mechanistically, IL-10 activated the IL-10R/STAT3 signaling pathway and upregulated the DLK1/AMPK/ACC axis. Subsequently, IL-10 reprogrammed lipid metabolism and reduced lipid ROS accumulation. In addition, in an autologous blood injection intracerebral hemorrhagic stroke (ICH) mouse model, deficiency of the endogenous Il-10, specific knocking out Il10r or Dlk1 in OPCs, or administration of ACC inhibitor was associated with increased OPC cell death, demyelination, axonal sprouting, and the cognitive deficits during the chronic phase of ICH and vice versa. These data suggest that IL-10 protects against OPC loss and white matter injury by reducing lipid ROS, supporting further development of potential clinical applications to benefit patients with stroke and related disorders.

Utility of a novel Exoscope, ORBEYE, in re-resection for recurrent brain tumor

BackgroundRe-resections is one of the treatment options for recurrence brain tumors, including both benign and malignant brain tumors, such as meningioma and glioblastoma. Re-resection for recurrent brain tumor sometimes needs extension of original craniotomy. However, extending original craniotomy is troublesome and can easily damage the adhered brain tissue and reconstruct of bone flap sometimes cause cosmetic problems, thus ideal way to re-resect recurrent brain tumor is to use the same original craniotomy.However, when using an operative microscope, performing re-resections without extending craniotomy requires the surgeon to operate in an awkward position. A recently developed high-definition (4 K-HD) 3-D exoscope system, ORBEYE, can improve this problem. In this study, we analyzed the utility of 4 K-HD 3-D exoscope system, ORBEYE, for re-resecting recurrent brain tumor. MethodsWe report 32 cases managed by re-resecting recurrent brain tumor by ORBEYE. Perioperative clinical, surgical, and radiographic data were retrospectively examined. ResultsRe-resecting tumors for recurrent brain tumor by ORBEYE were successfully performed for all 32 resections, using ORBEYE, without any severe postoperative neurological deficit. In addition, we could avoid extending original craniotomy as much as possible by adjusting the ORBEYE camera angle. ConclusionRe-resecting tumors for recurrent brain tumors by ORBEYE are feasible and can avoid extending original craniotomy as much as possible.

Positive Neuroprotective Effect of Argon Inhalation after Photochemically Induced Ischemic Stroke Model in Rats.

We studied the effect of 2-h inhalation of argon-oxygen mixture (Ar 70%/O2 30%) after photochemically induced stroke and on days 2 and 3 after stroke modeling on the severity of neurological deficit and brain damage (by MRI data) in Wistar rats. Neurological deficit was assessed within 14 days using the limb placement test. MRI and histological study of the brain with an assessment of the size of damage were performed on day 14 after ischemia. Significant differences were obtained in limb placement scores on days 3, 7, and 14, as well as in the volume of ischemic focus by MRI in comparison with the control (ischemia+N2 70%/O2 30%). Inhalation of argon-oxygen mixture for 2 h a day over 3 days after photoinduced stroke decreased the volume of brain damage by 2 times and reduced the severity of neurological deficit.

Tubercolosi vertebrale atipica: un caso clinico e revisione della letteratura

Background - Rates of Extrapulmonary Tuberculosis (TB) are higher in paediatric patients, especially in those from endemic areas. Bone TB is mostly located in the spine and in children may cause rapid bone destruction with severe deformity and neurological deficits. Case report - The paper reports the case of a 14-year-old male patient from Pakistan presenting with neurological symptoms and neuroradiological features suspicious for malignant tumour. After surgical removal of the mass, PCR test showed spinal TB. Tuberculin skin test (TST) and Interferon-Gamma Release Assays (IGRA) resulted negative. Discussion - False negative IGRA and TST test results can occur due to several factors, including immunodeficiency disorders. Some cases of spinal TB do not have typical radiological features, causing diagnostic delays or mistakes. Non-typical spinal TB features include: (1) involvement of the posterior elements of the spinal column; (2) skip lesions; (3) non-osseous TB involving spinal cord, cauda equina, and/or meninges. Conclusion - The differential diagnosis between spinal TB and malignancy might be challenging. Consequently, considering TB in children with neurological symptoms and/or vertebral neoformation, especially in patients coming from endemic areas, is recommended. TB diagnosis should not be excluded in case of non-typical radiological features, negative TST and IGRA or history of anti-TB vaccination. This approach should facilitate a timely diagnosis for appropriate treatment, avoiding neurological sequalae and delayed deformities.

Morphological and functional cardiac alterations in children with congenital Zika syndrome and severe neurological deficits.

Zika virus infection during pregnancy causes fetal microcephaly and brain damage. Congenital Zika syndrome (CZS) is characterized by systemic involvement with diffuse muscle impairment, a high frequency of arthrogryposis, and microphthalmia. Cardiac impairment in CZS has rarely been evaluated. Our study assessed morphology and biventricular cardiac function in children with CZS and advanced neurological dysfunction. This cross-sectional study was conducted on 52 children with CZS (Zika group; ZG) and 25 healthy children (control group; CG) in Paraiba, Brazil. Clinical evaluation, electrocardiogram (EKG), and transthoracic echocardiogram (TTE) were performed on all children. Additionally, troponin I and natriuretic peptide type B (BNP) levels, the degree of cerebral palsy, and neuroimaging findings were assessed in the ZG group. The median age of the study population was 5 years in both groups, and 40.4% (ZG) and 60% (CG) were female. The most prevalent electrocardiographic alteration was sinus arrhythmia in both the ZG (n = 9, 17.3%) and CG (n = 4, 16%). The morphological parameters adjusted for Z score were as follows: left ventricular (LV) end-diastolic diameter in ZG: -2.36 [-5.10, 2.63] vs. CG: -1.07 [-3.43, 0.61], p<0.001); ascending aorta (ZG: -0.09 [-2.08, 1.60] vs. CG: 0.43 [-1.47, 2.2], p = 0.021); basal diameter of the right ventricle (RV) (ZG: -2.34 [-4.90, 0.97] vs. CG: -0.96 [-2.21, 0.40], p<0.01); and pulmonary artery dimension (ZG: -2.13 [-5.99, 0.98] vs. CG: -0.24 [-2.53, 0.59], p<0.01). The ejection fractions (%) were 65.7 and 65.6 in the ZG and CG, respectively (p = 0.968). The left atrium volume indices (mL/m2) in the ZG and CG were 13.15 [6.80, 18.00] and 18.80 [5.90, 25.30] (p<0.01), respectively, and the right atrium volume indices (mL/m2) were 10.10 [4.90, 15.30] and 15.80 [4.10, 24.80] (p<0.01). The functional findings adjusted for Z score were as follows: lateral systolic excursion of the mitral annular plane (MAPSE) (ZG: 0.36 [-2.79, 4.71] vs. CG: 1.79 [-0.93, 4.5], p = 0.001); tricuspid annular plane systolic excursion (TAPSE) (ZG: -2.43 [-5.47, 5.09] vs. CG: 0.07 [-1.98, 3.64], p<0.001); and the S' of the RV (ZG: 1.20 [3.35, 2.90] vs. CG: -0.20 [-2.15, 1.50], p = 0.0121). No differences in biventricular strain measurements were observed between the groups. Troponin I and BNP levels were normal in in the ZG. Grade V cerebral palsy and subcortical calcification were found in 88.6% and 97.22% of children in the ZG group, respectively. A reduction in cardiac dimensions and functional changes were found in CZS patients, based on the TAPSE, S' of the RV, and MAPSE, suggesting the importance of cardiac evaluation and follow-up in this group of patients.

Intracerebral Hemorrhage Leads to Anemia By Disrupting Erythropoiesis and Erythromyeloblastic Islands

Intracerebral hemorrhage (ICH), caused by the rupture of a cerebral vessel and subsequent entry of blood into the brain parenchyma, is a major form of acquired brain injury and contributes a remarkable proportion of stroke-related morbidity and mortality. Due to the few proven effective emergency and preventive treatments, patients who survived suffer varying degrees of poor prognosis that affect their quality of life. There is an urgent need to explore the cellular and molecular basis of the differences in the severity and prognosis of ICH. Anemia is a common manifestation of ICH. However, the mechanisms underlying ICH-induced anemia as we as the correlation between anemia and ICH progression/prognosis remain unclear. In this study, we found that approximately 35.1% (39 of 111) of ICH patients exhibited anemia and that decreased hemoglobin levels were positively associated with higher scores on the National Institutes of Health Stroke Scale, which quantifies the degree of neurological deficit, at admission. Furthermore, patients with decreased hemoglobin levels at admission showed higher modified Rankin scale scores at 3 months, which reflect the global disability of daily living at this time, suggesting that anemia was associated with a more severe progression and poor patient prognosis. To investigate the effects of ICH on bone marrow (BM) erythropoiesis, we conducted experiments in 12-month-old mice with collagenase-induced striatal ICH. Our results showed that ICH caused apparent anemia on day 3, associated with larger hematomas in the striatum and more severe neurologic deficits. We first evaluated the phenotype of hematopoietic progenitors and found that mice suffering ICH exhibited increased granulocyte monocyte progenitors but a significant decrease in common myeloid progenitors and megakaryocyte erythrocyte progenitors compared to control mice, suggesting a reduced source of erythroid progenitors. Further analysis revealed that the colony-forming ability of erythroid progenitors and subsequent terminal differentiation was significantly suppressed after ICH. To assess whether ICH-induced suppression of erythropoiesis is associated with erythromyeloblastic islands (EMBIs), the niche for erythropoiesis/myelopoiesis, we performed ICH using 12-month-old EpoR-tdTomato-Cre mice and found that the number of BM EMBIs and EpoR + macrophages decreased significantly. Moreover, the number and proportion of developing erythroid cells surrounding EMBIs decreased while LY6G + cells representing granulocytes increased prominently, indicating an altered microenvironment, with EMBI favoring granulopoiesis over erythropoiesis after ICH. Studies have shown that inflammation plays a crucial role in secondary brain injury after ICH. We hypothesize that inflammatory cytokines may contribute to the suppression of erythropoiesis observed in ICH mouse models. To test this, we measured inflammatory factors in both peripheral blood and BM fluid using Quantibody Mouse Inflammation Array. In particular, IL-6 concentrations in peripheral blood and BM fluid in ICH mice were significantly higher than controls. Treatment with MR16-1, an IL-6 antagonist, alleviated ICH-induced anemia and improved BM erythropoiesis in ICH mice, as evidenced by increased peripheral red blood cells and hemoglobin levels, elevated numbers of erythroid progenitors and terminal erythroblast. MR16-1 treatment also improved BM EMBI formation and increased EpoR + macrophages. In addition, MR16-1 treatment effectively improved neurologic deficits and reduced brain hematoma after ICH. Administration of recombinant IL-6 to wild-type mice resulted in decreased levels of red blood cells and hemoglobin along with suppression of erythropoiesis in the BM. Collectively, these results suggest that ICH modulates erythropoiesis and erythromyeloblastic islands function to ultimately lead to anemia and reveal a possible therapeutic opportunity to reverse ICH-induced anemia and improve ICH prognosis by targeting IL-6.

Cerebral sparganosis: rare parasitic infection of the brain

Spirometra is larval cestode that involve humans as accidental intermediate hosts. Although the incidence of central nervous system infestation with sparganum is low, the diagnosis of the disease can cause delayed with an increased possibility of severe brain damage and neurological deficits. The present case reports a case of a 19-year male student and describes the imaging findings, histopathological characteristics, and management of this rare disease. The patient was treated surgically with good outcome.

Microglia/macrophages are ultrastructurally altered by their proximity to spinal cord injury in adult female mice

Traumatic spinal cord injury can cause immediate physical damage to the spinal cord and result in severe neurological deficits. The primary, mechanical tissue damage triggers a variety of secondary damage mechanisms at the injury site which significantly contribute to a larger lesion size and increased functional damage. Inflammatory mechanisms which directly involve both microglia (MG) and monocyte-derived macrophages (MDM) play important roles in the post-injury processes, including inflammation and debris clearing. In the current study, we investigated changes in the structure and function of MG/MDM in the injured spinal cord of adult female mice, 7 days after a thoracic contusion SCI. With the use of chip mapping scanning electron microscopy, which allows to image large samples at the nanoscale, we performed an ultrastructural comparison of MG/MDM located near the lesion vs adjacent regions to provide novel insights into the mechanisms at play post-injury. We found that MG/MDM located near the lesion had more mitochondria overall, including mitochondria with and without morphological alterations, and had a higher proportion of altered mitochondria. MG/MDM near the lesion also showed an increased number of phagosomes, including phagosomes containing myelin and partiallydigested materials. MG/MDM near the injury interacted differently with the spinal cord parenchyma, as shown by their reduced number of direct contacts with synaptic elements, axon terminals and dendritic spines. In this study, we characterized the ultrastructural changes of MG/MDM in response to spinal cord tissue damage in mice, uncovering changes in phagocytic activity, mitochondrial ultrastructure, and inter-cellular interactions within the spinal cord parenchyma.

LLDT-8 ameliorates experimental autoimmune encephalomyelitis by mediating macrophage functions in the priming stage

Multiple sclerosis (MS) is an inflammatory demyelinating disease in the central nervous system caused by T cell activation mediated by peripheral macrophages, resulting in severe neurological deficits and disability. Due to the currently limited and expensive treatments for MS, we here introduce an economic Chinese medicine extract, (5R)-5-Hydroxytriptolide (LLDT-8), which shows low toxicity and high immunosuppressive activity. We used the widely accepted mouse model of MS, experimental autoimmune encephalomyelitis (EAE), to examine the immunosuppressive effect of LLDT-8 in vivo. Through the RNA-sequence analysis of peripheral macrophages in EAE mice, we discovered that LLDT-8 alleviates the symptoms of EAE by inhibiting the proinflammatory effect of macrophages, thereby blocking the activation and proliferation of T cells. In all, we found that LLDT-8 could be a potential treatment for MS.

Social Determinants of Health Impact Spinal Cord Injury Outcomes in Low- and Middle-Income Countries: A Meta-Epidemiological Study.

Traumatic spinal cord injuries (SCI), which disproportionally occur in low- and middle-income countries (LMICs), pose a significant global health challenge. Despite the prevalence and severity of SCI in these settings, access to appropriate surgical care and barriers to treatment remain poorly understood on a global scale, with data from LMICs being particularly scarce and underreported. This study sought to examine the impact of social determinants of health (SDoH) on the pooled in-hospital and follow-up mortality, and neurological outcomes, after SCI in LMICs. A systematic review was conducted in adherence to the Preferred Reporting in Systematic Review and Meta-Analysis-guidelines. Multivariable analysis was performed by multivariable linear regression, investigating the impact of the parameters of interest (patient demographics, country SDoH characteristics) on major patient outcomes (in-hospital/follow-up mortality, neurological dysfunction). Forty-five (N = 45) studies were included for analysis, representing 13 individual countries and 18 134 total patients. The aggregate pooled in-hospital mortality rate was 6.46% and 17.29% at follow-up. The in-hospital severe neurological dysfunction rate was 97.64% and 57.36% at follow-up. Patients with rural injury had a nearly 4 times greater rate of severe in-hospital neurological deficits than patients in urban areas. The Gini index, reflective of income inequality, was associated with a 23.8% increase in in-hospital mortality, a 20.1% decrease in neurological dysfunction at follow-up, and a 12.9% increase in mortality at follow-up. This study demonstrates the prevalence of injury and impact of SDoH on major patient outcomes after SCI in LMICs. Future initiatives may use these findings to design global solutions for more equitable care of patients with SCI.

NCOG-11. PREOPERATIVE NANO SCORE AS A PREDICTOR FOR SURVIVAL IN GLIOBLASTOMA

Abstract BACKGROUND Age, molecular features, extent of resection, and adjuvant treatment are well established prognostic factors for patients with glioblastoma. Neurological Assessment in Neuro-Oncology (NANO) Scale was designed as a tool to provide an objective clinician-reported outcome of neurologic and complements the radiological evaluation of the Response Assessment in Neuro-Oncology (RANO) criteria. Despite the generally detrimental prognosis associated with severe new neurological deficits after surgery, a comprehensive understanding of the impact of pre- and postoperative neurological status remains limited. This study explores the potential of the NANO scale to predict survival when applied immediately before and after surgery. METHODS This retrospective study examined adult patients in South-Eastern Norway who underwent resection for IDH wildtype glioblastoma between January 2020 and December 2021. We used Kaplan Meier curve calculate median overall survival and chi-square and log rank test were used to compare groups. RESULTS The study included 187 patients, with a median overall survival was 14.9 months. Patients with a preoperative NANO-score of 0-2 had a median survival of 17.4 months, compared to 11.3 months for patients scoring 3 or more points (p&amp;lt; 0.001). Neither Postoperative NANO scores nor changes in NANO scores in pre- to postoperative score were found to be significant predictors for survival. CONCLUSIONS This study indicates that a low preoperative NANO were predictive for a longer median survival, whereas postoperative NANO scores didn’t show the same impact. Surprisingly, an increase in the postoperative NANO score, indicating new, or worsening of the neurological deficits, didn′t correlate with a shorter median survival.