scholarly journals Differential Diagnosis of the Dementias of Unknown Origin: A Clinician's View

1986 ◽  
Vol 13 (S4) ◽  
pp. 381-382 ◽  
Author(s):  
V.A. Kral
Keyword(s):  
Rural Areas ◽  
Unknown Origin ◽  
Brain Parenchyma ◽  
Laboratory Research ◽  
Cerebral Vasculature ◽  
Pathogenetic Mechanism ◽  
Number Of Patients ◽  
Life Threatening ◽  
Close Cooperation ◽  
The Brain

Abstract:The close cooperation of clinical and laboratory research has helped to clarify the etiology of some of the dementing processes of the senium. However, the necessary investigations are complicated, laborious, expensive and can be carried out only in well equipped centres in larger cities. This restricts the number of patients who eventually may benefit from these investigations to a small number. What is needed for the psychogeriatric practice particularly in rural areas and smaller cities are simple diagnostic guidelines for the psychiatrist to answer the question whether the patient suffers from a dementia and if so whether the dementia is in all probability due to a primary degenerative process of the brain parenchyma or of the cerebral vasculature or is it due to another cause.If degeneration of the brain parenchyma seems the prevalent pathogenetic mechanism one would like to establish in a given case which of the known degenerative processes is most probably present in order to avoid mistakes in clinical judgement with their often life threatening consequences.

Selected Infectious Disease Emergencies

2020 ◽  
pp. 115-122
Author(s):  
Scott Kobner ◽  
Emily Rose
Keyword(s):  
Infectious Disease ◽  
Bartonella Henselae ◽  
Viral Meningitis ◽  
Brain Parenchyma ◽  
Retropharyngeal Abscess ◽  
Cat Fleas ◽  
Life Threatening ◽  
Tissue Space ◽  
Atypical Presentations ◽  
The Brain

Fever is common in children, and serious etiologies with significant sequelae must be identified and treated. This chapter discusses the classic and atypical presentations of several important pediatric infectious disease conditions, including bacterial and viral meningitis (inflammation of the meninges that typically occurs in response to an infectious process), infectious encephalitis (inflammation of the brain parenchyma that presents clinically with neurologic dysfunction), retropharyngeal abscess (a potentially life-threatening airway emergency secondary to an infection of the retropharyngeal soft tissue space), and cat scratch disease secondary to Bartonella henselae infection (an infectious lymphadenopathy after exposure to cats or cat fleas). Diagnostic confirmation and treatment of these conditions are also discussed.

Encephalitis

2016 ◽  
Author(s):  
Tyler Martinez
Keyword(s):  
Psychiatric Symptoms ◽  
Signs And Symptoms ◽  
Brain Parenchyma ◽  
Stiff Neck ◽  
Meningeal Irritation ◽  
Decompressive Craniotomy ◽  
Brainstem Compression ◽  
Life Threatening ◽  
Immunocompromised State ◽  
The Brain

Encephalitis is an inflammation of the brain parenchyma, typically due to a viral infection. Pure encephalitis will lack the signs and symptoms of meningeal irritation (eg, stiff neck and photophobia). New-onset seizures, cognitive deficits, new psychiatric symptoms, lethargy/coma, cranial nerve abnormalities, or movement disorders should alert the clinician to possible encephalitis. It is important to question the patient about foreign travel, immunocompromised state, and potential exposures. Empiric treatment for presumed viral encephalitis is with the antiviral acyclovir. Empiric broad-spectrum antibiotics are also typically given to cover for possible bacterial meningitis. If there are signs of elevated intracranial pressure (ICP), neurosurgical consultation should be obtained for possible decompressive craniotomy. Standard therapy for ICP (ie, hyperventilation, steroids, mannitol, hypertonic saline, and elevation of the head of the bed) should also be considered. The most concerning complication of encephalitis is the development of life-threatening cerebral edema with resultant brainstem compression and herniation.

Penetrating knife injury to the skull: A case report in pediatric neurosurgical care

Trauma ◽  
2016 ◽  
Vol 19 (4) ◽  
pp. 302-307
Author(s):  
Tene A Cage ◽  
Nader Sanai ◽  
Michael T Lawton ◽  
Kurtis I Auguste
Keyword(s):  
Pediatric Population ◽  
Tertiary Care ◽  
Interdisciplinary Team ◽  
Brain Parenchyma ◽  
Cerebral Vasculature ◽  
Local Trauma ◽  
Tertiary Care Centers ◽  
Knife Injury ◽  
Neurologically Intact ◽  
The Brain

Isolated penetrating head injury in children is rare and is usually accidental. Each case is unique since the penetrating object and the trajectory through the brain parenchyma vary greatly among patients. We present a three-year-old girl who presented with a kitchen utility knife penetrating her left midface, skull, and brain abutting the anterior cerebral vasculature. Though the patient initially presented to a local trauma center, there were no pediatric nor vascular neurosurgeons on staff. Thus, she was transferred to our tertiary facility for definitive surgical management. A pediatric and vascular neurosurgeon worked together to remove the knife safely and the underlying vasculature remained intact. Postoperatively, the patient did well and was neurologically intact. Though penetrating cranial injury is rare in the pediatric population, such complex cases of brain injury can be properly managed with good outcome by an interdisciplinary team of specialists in tertiary care centers and can result in an excellent surgical and functional outcome for the patient.

Changes in Coagulation following Brain Injury

2020 ◽  
Vol 46 (02) ◽  
pp. 155-166
Author(s):  
Marc Maegele ◽  
John Aversa ◽  
Mathew K. Marsee ◽  
Ross McCauley ◽  
Swetha Hanuma Chitta ◽  
...  
Keyword(s):  
Brain Injury ◽  
Point Of Care ◽  
Activated Protein C ◽  
Brain Parenchyma ◽  
Health Concern ◽  
Cerebral Vasculature ◽  
Clinical Presentations ◽  
Initial Injury ◽  
The Brain ◽  
Supporting Structures

AbstractTraumatic brain injury (TBI) is a worldwide public health concern due to increasing mortality, affecting around 10 million patients per year. A wide variety of clinical presentations are a function of the magnitude of injury and the anatomical perturbation of the brain parenchyma, supporting structures, and cerebral vasculature, with subsequent alteration of the blood–brain barrier. These disturbances correspond with the evolution of intracerebral hemorrhage and clinical outcomes. The associated hemostatic alterations associated with TBI are caused by the disruption of the delicate balance between bleeding and thrombosis formation, which can exacerbate initial injury. TBI-associated coagulopathy is a function of a cross-talk between coagulation and inflammation, with varying influences on the immunomodulation and regulation of coagulation that occur on platelets and the endothelium of injured TBI patients. In addition to the severity of initial injury, the following factors modulate the hemocoagulative response to TBI: time from the onset of injury to treatment, age, gender, catecholamine secretion, platelet dysfunction, endotheliopathy, premorbid anticoagulation, fibrinolysis, tissue factor, and activated protein C contribution. All these entities are intertwined and influence the pathologic evolution of TBI. These factors have implications for therapeutic options such as the choice of blood components for transfusion and hemostatic agents such as tranexamic acid. Monitoring hemostatic changes of TBI patients requires an understanding of these interactions between immunology and coagulation, which can be discerned by point-of-care viscoelastic testing with specific limitations. This review considers the implications of these interrelated influences on the evaluation of coagulopathy in TBI.

scholarly journals Spatial heterogeneity of glioblastoma cells reveals sensitivity to NAD+ depletion at tumor edge

2020 ◽  
Author(s):  
Daisuke Yamashita ◽  
Davide Botta ◽  
Hee Jin Cho ◽  
Xiaoxian Guo ◽  
Saya Ozaki ◽  
...  
Keyword(s):  
Phenotypic Diversity ◽  
Experimental Models ◽  
Brain Parenchyma ◽  
Life Threatening ◽  
Tumor Edge ◽  
Surgical Treatments ◽  
Clinical Potential ◽  
Cancerous Cells ◽  
The Brain

ABSTRACTEven after total resection of glioblastoma core lesions by surgery and aggressive post-surgical treatments, life-threatening tumors inevitably recur. A characteristic obstacle in effective treatment is high intratumoral heterogeneity, both longitudinally and spatially. Recurrence occurs predominantly at the brain parenchyma-tumor core interface, a region termed tumor edge. Given the difficulty of accessing it surgically, the composition of the tumor edge, harboring both cancerous and non-cancerous cells, remains largely unknown. Here, to identify phenotypic diversity among heterogeneous glioblastoma core and edge lesions, we uncovered the existence of three phenotypically-distinct clonal subpopulations within individual tumors from glioblastoma patients. Clones from the tumor core shared the same phenotype, exclusively generating tumor-core cells. In contrast, two distinct clonal subtypes were identified at the tumor edge: one generated only edge-lesion cells and the other expanded more broadly to establish both edge- and core-lesions. Using multiple xenograft experimental models in mouse brains, tumor edge development was found to require that both somatic and tumor cells express the NADase CD38, combinedly elevating glioblastoma malignancy. In vitro data suggested that intracellular NADase activity at the edge was provoked through intercellular communication between edge clones and normal astrocytes. Systemic treatment of tumor-bearing mice with 78c, a small-molecule CD38 inhibitor, attenuated the formation of glioblastoma edge lesions, suggesting its clinical potential to pharmacologically eliminate tumor-edge lesions. Collectively, these findings provide novel phenotypic and mechanistic insights into clonal heterogeneity within glioblastoma, particularly in the surgically unresectable, currently understudied tumor edge.

scholarly journals Group G Streptococci in association with brain abscess: a rare occurrence

2014 ◽  
Vol 8 (11) ◽  
pp. 1488-1490
Author(s):  
Parimala Subramani ◽  
Vidhya Raja ◽  
Bipinchandra Bhagath Lingaiah ◽  
Beena Prasavangada Madappa ◽  
Hariprakash Chakravarthy
Keyword(s):  
Brain Abscess ◽  
Congenital Anomalies ◽  
Rare Case ◽  
Female Child ◽  
Brain Parenchyma ◽  
Neurological Symptoms ◽  
Rare Occurrence ◽  
Group G Streptococci ◽  
Life Threatening ◽  
The Brain

Brain abscess is a serious life-threatening infection of the brain parenchyma. We are reporting a rare case of brain abscess caused by Group G Streptococcus in a 12 year-old female child who presented with neurological symptoms. She was diagnosed with congenital anomalies of the heart at birth. She was treated with amoxyclav and ciprofloxacin. The child recovered and was discharged uneventfully.

Ion Channel Remodelling in Atrial Fibrillation

2011 ◽  
Vol 7 (2) ◽  
pp. 97 ◽  
Author(s):  
Niels Voigt ◽  
Dobromir Dobrev ◽  
◽  
Keyword(s):  
Atrial Fibrillation ◽  
Ion Channel ◽  
Antiarrhythmic Drugs ◽  
Current Knowledge ◽  
Bleeding Complications ◽  
Large Size ◽  
Cardiovascular Morbidity And Mortality ◽  
Number Of Patients ◽  
Life Threatening ◽  
Underlying Mechanisms

Atrial fibrillation (AF) is the most common arrhythmia and is associated with substantial cardiovascular morbidity and mortality, with stroke being the most critical complication. Present drugs used for the therapy of AF (antiarrhythmics and anticoagulants) have major limitations, including incomplete efficacy, risks of life-threatening proarrhythmic events and bleeding complications. Non-pharmacological ablation procedures are efficient and apparently safe, but the very large size of the patient population allows ablation treatment of only a small number of patients. These limitations largely result from limited knowledge about the underlying mechanisms of AF and there is a hope that a better understanding of the molecular basis of AF may lead to the discovery of safer and more effective therapeutic targets. This article reviews the current knowledge about AF-related ion-channel remodelling and discusses how these alterations might affect the efficacy of antiarrhythmic drugs.

A simple treatment planning strategy for patients with multiple metastases treated with Gamma Knife surgery

2006 ◽  
Vol 105 (Supplement) ◽  
pp. 2-4 ◽  
Author(s):  
James G. Douglas ◽  
Robert Goodkin
Keyword(s):  
Mr Imaging ◽  
Treatment Planning ◽  
Gamma Knife ◽  
Gamma Knife Surgery ◽  
Planning Method ◽  
Cns Metastases ◽  
Cell Lung Carcinoma ◽  
Dose Volume Histograms ◽  
Number Of Patients ◽  
The Brain

ObjectIn a substantial number of patients treated at the authors' facility for brain metastases, additional lesions are identified at the time of Gamma Knife surgery (GKS). These lesions are often widely dispersed and may number over 10, which is the maximal number of matrices that can be currently placed for treatment with Leksell Gamma-Plan 4C. The authors describe a simple planning method for GKS in patients with multiple, widely dispersed central nervous system (CNS) metastases.MethodsTwo patients presented with three to five identified recurrent metastases from non–small cell lung carcinoma and breast carcinoma after having received whole-brain radiotherapy. At the time of treatment with GKS in each patient, spoiled-gradient Gd-enhanced magnetic resonance (MR) imaging revealed substantially more metastases than originally thought, which were widely scattered throughout all regions of the brain. The authors simplified the treatment planning approach by dividing the entire CNS contents into six contiguous, nonoverlapping matrices, which allowed for the planning, calculation, and treatment of all lesions.Two patients were successfully treated with GKS for more than 10 CNS metastases by using this simple planning method. Differing peripheral doses to varied-size lesions were delivered by prescribing to different isodose curves within any given matrix when required. Dose–volume histograms showed brain doses as follows: 10% of the total brain volume received 5 to 6.4 Gy; 25% received 3.8 to 4.8 Gy; 50% received 2.7 to 3.1 Gy; and 75% received 2.2 to 2.5 Gy.Conclusions The delineation of more metastases than appreciated on the diagnostic MR imaging is a common occurrence at the time of GKS at the authors' institution. The treatment of multiple (>10), widely dispersed CNS metastases can be simplified by the placement of multiple, contiguous, non-overlapping matrices, which can be employed to treat lesions in all areas of the brain when separate matrices cannot be utilized.

Possibility that the Onset of Autism Spectrum Disorder is Induced by Failure of the Glutamine-Glutamate Cycle

2020 ◽  
Vol 14 (2) ◽  
pp. 170-174
Author(s):  
Koichi Kawada ◽  
Nobuyuki Kuramoto ◽  
Seisuke Mimori
Keyword(s):  
Autism Spectrum Disorder ◽  
Endoplasmic Reticulum ◽  
Environmental Factors ◽  
Endoplasmic Reticulum Stress ◽  
Synapse Formation ◽  
Autism Spectrum ◽  
Spectrum Disorder ◽  
Neurodevelopmental Disease ◽  
Number Of Patients ◽  
The Brain

: Autism spectrum disorder (ASD) is a neurodevelopmental disease, and the number of patients has increased rapidly in recent years. The causes of ASD involve both genetic and environmental factors, but the details of causation have not yet been fully elucidated. Many reports have investigated genetic factors related to synapse formation, and alcohol and tobacco have been reported as environmental factors. This review focuses on endoplasmic reticulum stress and amino acid cycle abnormalities (particularly glutamine and glutamate) induced by many environmental factors. In the ASD model, since endoplasmic reticulum stress is high in the brain from before birth, it is clear that endoplasmic reticulum stress is involved in the development of ASD. On the other hand, one report states that excessive excitation of neurons is caused by the onset of ASD. The glutamine-glutamate cycle is performed between neurons and glial cells and controls the concentration of glutamate and GABA in the brain. These neurotransmitters are also known to control synapse formation and are important in constructing neural circuits. Theanine is a derivative of glutamine and a natural component of green tea. Theanine inhibits glutamine uptake in the glutamine-glutamate cycle via slc38a1 without affecting glutamate; therefore, we believe that theanine may prevent the onset of ASD by changing the balance of glutamine and glutamate in the brain.

Fact file 1: Critical care and emergency medicine

2017 ◽  
Author(s):  
Daisy Fancourt
Keyword(s):  
Emergency Medicine ◽  
Critical Care ◽  
Sports Medicine ◽  
Orthopaedic Surgery ◽  
Extreme Environment ◽  
Disaster Medicine ◽  
Medical Attention ◽  
Life Threatening ◽  
Medical Disciplines ◽  
The Brain

Emergency medicine involves the care of patients who require immediate medical attention. The specialty encompasses a broad range of medical disciplines, including anaesthesia, cardiology (a field related to the heart), neurology (a field related to the brain), plastic surgery, orthopaedic surgery (surgery relating to the bones or muscles), and cardiothoracic surgery (surgery relating to the heart, chest, or lungs). There are also a number of subspecialties including extreme environment medicine, disaster medicine and sports medicine. Related to emergency medicine is the specialty of critical care medicine, which is concerned with the care of patients with life-threatening conditions often treated in intensive care settings....

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