Monitoring Criteria of Intracranial Lesions in Children Post Mild or Moderate Head Trauma

2018 ◽  
Vol 49 (06) ◽  
pp. 385-391
Author(s):  
Sergio Boetto ◽  
Annick Sevely ◽  
Jean-Christophe Sol ◽  
Yves Chaix ◽  
Emmanuel Cheuret ◽  
...  
Keyword(s):  
Head Trauma ◽  
Treatment Guidelines ◽  
Clinical Symptoms ◽  
Late Onset ◽  
Brain Lesion ◽  
Clinical Signs ◽  
Duration Of Hospitalization ◽  
Intracranial Lesions ◽  
The Brain

AbstractHead injury is the most common cause of child traumatology. However, there exist no treatment guidelines in children having intracranial lesions due to minor or moderate head trauma. There is little knowledge about monitoring, clinical exacerbation risk factors, or optimal duration of hospitalization. The aim of this retrospective study is to find predictive factors in the clinical course of non-severe head trauma in children, and thus to determine an optimal management strategy. Poor clinical progress was observed in only 4 out of 113 children. When there are no clinical signs and no eating disorders, an earlier discharge is entirely appropriate. Nevertheless, persistent clinical symptoms including headache, vomiting, and late onset seizure, especially in conjunction with hemodynamic disorders such as bradycardia, present a risk of emergency neurosurgery or neurological deterioration. Special attention should be paid to extradural hematoma (EDH) of more than 10 mm, which can have the most severe consequences. Clinical aggravation does not necessarily correlate with a change in follow-up imaging. Conversely, an apparent increase in the brain lesion on the scan is not consistently linked to a pejorative outcome.

scholarly journals Concentrations of canine prostate specific esterase, CPSE, at baseline are associated with the relative size of the prostate at three-year follow-up

2021 ◽  
Vol 17 (1) ◽  
Author(s):  
Bodil S. Holst ◽  
Sofia Carlin ◽  
Virginie Fouriez-Lablée ◽  
Sofia Hanås ◽  
Sofie Ödling ◽  
...  
Keyword(s):  
Clinical Symptoms ◽  
Specific Antigen ◽  
Relative Size ◽  
Clinical Signs ◽  
Serum Concentrations ◽  
Prostatic Disease ◽  
Follow Up Study ◽  
Prostate Size ◽  
Prostate Growth

Abstract Background Enlargement of the prostate is associated with prostatic diseases in dogs, and an estimation of prostatic size is a central part in the diagnostic workup. Ultrasonography is often the method of choice, but biomarkers constitute an alternative. Canine prostate specific esterase (CPSE) shares many characteristics with human prostate specific antigen (PSA) and is related to prostate size. In men with clinical symptoms of prostatic disease, PSA concentrations are related to prostate growth. The aims of the present follow-up study were to evaluate if the concentration of CPSE is associated with future growth of the prostate, and if analysis of a panel of 16 steroids gives further information on prostatic growth. Owners of dogs included in a previous study were 3 years later contacted for a follow-up study that included an interview and a clinical examination. The prostate was examined by ultrasonography. Serum concentrations of CPSE were measured, as was a panel of steroids. Results Of the 79 dogs included at baseline, owners of 77 dogs (97%) were reached for an interview, and 22 were available for a follow-up examination. Six of the 79 dogs had clinical signs of prostatic disease at baseline, and eight of the remaining 73 dogs (11%) developed clinical signs between baseline and follow-up, information was lacking for two dogs. Development of clinical signs was significantly more common in dogs with a relative prostate size of ≥2.5 at baseline (n = 20) than in dogs with smaller prostates (n = 51). Serum concentrations of CPSE at baseline were not associated with the change in prostatic size between baseline and follow-up. Serum concentrations of CPSE at baseline and at follow-up were positively associated with the relative prostatic size (Srel) at follow-up. Concentrations of corticosterone (P = 0.024), and the class corticosteroids (P = 0.0035) were positively associated with the difference in Srel between baseline and follow-up. Conclusions The results support the use of CPSE for estimating present and future prostatic size in dogs ≥4 years, and the clinical usefulness of prostatic size for predicting development of clinical signs of prostatic disease in the dog. The association between corticosteroids and prostate growth warrants further investigation.

scholarly journals White Matter Integrity Changes and Neurocognitive Functioning in Adult-Late Onset DM1: A Follow-Up DTI Study

2021 ◽  
Author(s):  
Garazi Labayru ◽  
Borja Camino-Pontes ◽  
Antonio Jimenez-Marin ◽  
Joana Garmendia ◽  
Jorge Villanua ◽  
...  
Keyword(s):  
White Matter ◽  
Late Onset ◽  
Neurocognitive Functioning ◽  
Frontal Part ◽  
Multisystemic Disease ◽  
The Brain ◽  
Over Time ◽  
Anterior Posterior

Abstract Background: Myotonic Dystrophy Type 1 (DM1) is a multisystemic disease that affects gray and white matter (WM) tissues. WM changes in DM1 include increased hyperintensities and altered tract integrity distributed in a widespread manner. However, the precise spatiotemporal changes are yet undetermined. Methods: MRI data were acquired from 8 adult- and late-onset DM1 patients and 10 healthy controls (HC) at two different timepoints over 9.06 years. Fractional anisotropy (FA) variations were assessed with Tract-Based Spatial Statistics. Transversal and longitudinal intra- and intergroup analyses were conducted, along with correlation analyses with clinical and neuropsychological data.Results: At baseline, reduced FA values were found in patients in the uncinate, anterior-thalamic, fronto-occipital, and longitudinal tracts. At follow-up, the WM disconnection was shown to have spread from the frontal part to the rest of the tracts in the brain. Furthermore, WM lesion burden was negatively correlated with FA values, while visuo-construction and intellectual functioning were positively correlated with global and regional FA values at follow-up.Conclusion: DM1 patients showed a pronounced WM integrity loss over time compared to HC, with a neurodegeneration pattern that suggests a progressive anterior-posterior disconnection. The visuo-construction domain stands out as the most sensitive neuropsychological measure for WM microstructural impairment.

scholarly journals Brain and spine melanotic schwannoma: A rare occurrence and diagnostic dilemma

2019 ◽  
Vol 32 (5) ◽  
pp. 335-343
Author(s):  
Ali Alamer ◽  
Donatella Tampieri
Keyword(s):  
Brain Lesion ◽  
Clinical History ◽  
Diagnostic Dilemma ◽  
Melanotic Schwannoma ◽  
Post Surgery ◽  
Imaging Characteristics ◽  
Mri Features ◽  
Operative Notes ◽  
The Brain

Purpose Melanotic schwannoma (MS) was formerly known as a rare variant of schwannoma. The behavior of MS is unpredictable, with a tendency for recurrence and metastasis. The purpose of this study was to illustrate the imaging characteristics of these rare and misdiagnosed tumors. The prognosis of MS is discussed, along with the importance of follow-up exams to assess for recurrence and metastasis. Furthermore, we compare our results with those previously published on MS in order to have a better understanding of this rare entity. Methods Three MS cases were encountered between 2008 and 2015 at our institute. All available data were reviewed, including the clinical history, imaging findings, operative notes, and the histopathology results. A follow-up magnetic resonance imaging (MRI) scan was also reviewed up to 23 months post surgery to assess for recurrence. Results Three cases of MS are included: one in the brain and two in the spine. The brain lesion was in the occipital region. The spine lesions were thoracic intramedullary and sacral intradural. All cases were hypointense on T2-weighted imaging. Gross total resection was achieved for all lesions without adjuvant therapy. To date, the brain lesion recurred 15 months after surgery. Conclusions MS is a rare and distinct entity rather than a variant of schwannoma, and it poses both diagnostic and management dilemmas. Although MS has characteristic MRI features, including T1 and T2 shortening, the preoperative diagnosis is always challenging. Accurate diagnosis is crucial for management planning, including long-term follow-up exams to assess for recurrence and metastasis.

Surgical management of intracranial arachnoid cysts in pediatric patients: radiological and clinical outcome

2021 ◽  
pp. 1-11
Author(s):  
Matthias Schulz ◽  
Yasin Oezkan ◽  
Andreas Schaumann ◽  
Miriam Sieg ◽  
Anna Tietze ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Clinical Symptoms ◽  
Pediatric Population ◽  
Mass Effect ◽  
Reoperation Rate ◽  
Arachnoid Cysts ◽  
Cyst Volume ◽  
Intracranial Cysts ◽  
Intracranial Lesions

OBJECTIVE Congenital intracranial cysts account for a significant portion of intracranial lesions in the pediatric population. The efficiency of surgical treatment in a pediatric cohort with intracranial arachnoid cysts (ACs) at different locations regarding clinical symptoms and mass effect was evaluated. METHODS A retrospective study of all children who underwent surgical treatment of an intracranial AC during an 11-year period (2007–2018) was performed. Demographics, clinical symptoms, and radiological cyst size pre- and postoperatively, as well as the reoperation rate and possible treatment complications, were analyzed. RESULTS A total of 116 intracranial cysts at 8 different anatomical locations were surgically treated in 113 children (median age 5 years and 10 months) predominantly by endoscopic technique (84%). The complication rate was 3%, and the reoperation rate was 16%. Preoperative cyst enlargement was significantly more common in infants (p < 0.0001), as was the need for reoperation (p = 0.023). After a median radiological follow-up of 26 months, > 50% reduction of cyst volume was seen in 53 cysts (46%), and 47 cysts (40%) showed a 10%–50% reduction. Acute clinical symptoms improved: nausea and vomiting, accelerated head growth, and headaches improved at 100%, 92% and 89%, respectively. However, chronic symptoms responded less favorably after a median clinical follow-up of 26 months. CONCLUSIONS The strategy of predominantly endoscopic treatment with navigation planning is efficient to alleviate clinical symptoms and to significantly reduce the mass effect of pediatric intracranial cysts at different anatomical locations. The subgroup of infants requires close pre- and postoperative monitoring.

Gamma surgery for melanoma metastases in the brain

2002 ◽  
Vol 96 (3) ◽  
pp. 544-551 ◽  
Author(s):  
Vincenzo Mingione ◽  
Marcelo Oliveira ◽  
Dheerendra Prasad ◽  
Melita Steiner ◽  
Ladislau Steiner
Keyword(s):  
Brain Metastases ◽  
Survival Time ◽  
Cox Regression ◽  
Brain Lesion ◽  
High Dose ◽  
Content Type ◽  
Melanoma Metastases ◽  
The Brain ◽  
Fine Print

Object. The aim of this study was to evaluate the usefulness and limitations of gamma surgery (GS) in the treatment of brain metastases from melanoma. Methods. Imaging and clinical outcomes in 45 patients treated for 92 brain metastases from melanoma between October 1989 and October 1999 were retrospectively analyzed. Follow-up imaging studies were available in 35 patients with 66 treated lesions. Twenty-four percent of the lesions disappeared, 35% shrank, 23% remained unchanged, and 18% increased in size. No undue radiation-induced changes were observed in the surrounding brain. Clinical data were available in all patients. No deaths or neurological morbidity related to GS was observed. The median survival time, calculated using the Kaplan—Meier method, was 10.4 months from the time of GS. In both univariate and multivariate Cox regression analyses, a single brain lesion and lack of visceral metastases were statistically predictive of a better prognosis. Six of eight patients with solitary metastasis (that is, a single brain metastasis with no primary visceral tumor) were still alive at the close of the study, none of them with disease progression, with a follow-up period ranging between 14 and 82 months. Sixteen patients in this series received adjunctive whole-brain radiation therapy, which had no impact on their survival time or local and distant control of the brain disease. Conclusions. Gamma surgery is effective in treating melanoma metastases in the brain. It appears that the radiobiology of a single high dose overcomes the radioresistance barrier, yielding better results than fractionated radiation.

scholarly journals Alzheimer's disease-associated P460L mutation in ephrin receptor type A1 (EphA1) leads to dysregulated Rho-GTPase signaling

2021 ◽  
Author(s):  
Yoon Kim ◽  
Gorka Lasso ◽  
Hardik Patel ◽  
Badri Vardarajan ◽  
Ismael Santa-Maria ◽  
...  
Keyword(s):  
Rho Gtpase ◽  
Late Onset ◽  
Association Studies ◽  
Genome Wide Association Studies ◽  
Genome Wide ◽  
The Brain ◽  
Receptor Tyrosine Kinase Family

Recently, late onset AD (LOAD) genome-wide association studies identified EphA1, a member of receptor tyrosine kinase family (RTK) as a disease associated loci. In the follow-up study where 3 independent LOAD cohorts were performed, a P460L coding mutation in EphA1 loci showed a significant association with LOAD. However, the role of EphA1 and P460L mutant EphA1 in AD is not fully understood. We have characterized this mutation biophysically and biochemically. Our structural in silico model and in vitro biochemical analysis demonstrate that EphA1-P460L mutation makes the receptor constitutively active suggesting a gain-of-toxic function leading to chronic EphA1 signaling in the brain. Moreover, we report that the EphA1 P460L variant triggers Rho-GTPase signaling dysregulation that could potentially contribute to spine morphology abnormalities and synaptic dysfunction observed in AD pathology.

scholarly journals Cerebral equine hydatidosis in Southern Brazil

1997 ◽  
Vol 27 (2) ◽  
pp. 341-344 ◽  
Author(s):  
Jerônimo Lopes Ruas ◽  
Ana Lucia Schild ◽  
Cristina Gevehr Fernandes ◽  
João Luiz Montiel Ferreira ◽  
Gertrud Müller
Keyword(s):  
Lateral Ventricle ◽  
Third Ventricle ◽  
Brain Lesion ◽  
Clinical Signs ◽  
Occipital Lobe ◽  
Southern Brazil ◽  
The Third ◽  
Morphometric Features ◽  
The Brain ◽  
Gross Examination

Equine cerebral hydatid disease is described in a 7-year-old, crossbred, female horse. Clinical signs were characterized by circling gait, pressing of head against fences or objects and motor incoordination. On gross examination of the brain the hemispheres were swollen, mainly the left one. On transversal sections, a 5cm X 7cm fluid-filled cyst was observed within the lateral ventricle of the left hemisphere. The cyst extended from the parietal to the occipital lobe, and compressed the third ventricle. There was also marked mid line deviation. Histologically, the brain lesion adjacent to the cyst, was characterized by a piogranulomatous process and vacuolization of neuropil. A diagnosis of equine hydatidosis caused by Echinococcus granulosus was made on the basis of the morphometric features of protoscolices hooks.

Clinical utility of routine postoperative morning cortisol monitoring in detecting new hypothalamic-pituitary-adrenal axis insufficiency following endoscopic transsphenoidal surgery for sellar lesions

2020 ◽  
Vol 132 (4) ◽  
pp. 1054-1058
Author(s):  
Anna Jackanich ◽  
Sherwin Tavakol ◽  
Ben A. Strickland ◽  
Martin Rutkowski ◽  
Dina Kamel ◽  
...  
Keyword(s):  
Hpa Axis ◽  
Clinical Symptoms ◽  
Clinical Signs ◽  
Serum Cortisol ◽  
Screening Methods ◽  
Hypothalamic Pituitary Adrenal ◽  
Cavernous Sinus Invasion ◽  
Sellar Lesions ◽  
Cortisol Levels

OBJECTIVEHypothalamic-pituitary-adrenal (HPA) axis dysfunction is a well-documented complication of transsphenoidal craniotomy (TSC) for sellar lesions. The authors aimed to assess their multidisciplinary approach to the diagnosis and treatment of postoperative hypocortisolemia utilizing conservative screening methods.METHODSThe authors performed a retrospective review of 257 patients who underwent TSC for pituitary adenoma (PA) or Rathke cleft cyst (RCC) at the University of Southern California between 2012 and 2017. Patients with preoperative adrenal insufficiency, Cushing’s disease, or < 3 months of postoperative follow-up were excluded. Patient demographics, pathology, tumor characteristics, and complications were recorded. Postoperative day 1 (POD1) morning serum cortisol was assessed in all patients. Hypocortisolemia on POD1 (serum cortisol < 5 μg/dl) prompted a 7 am cortisol level measurement on POD 2 (POD2). Clinical signs and symptoms of hypocortisolemia were consistently monitored. After two serum cortisol levels < 5 μg/dl, or one serum level < 5 μg/dl plus a high clinical suspicion for HPA dysfunction, high-risk patients received glucocorticoid supplementation.RESULTSData on 165 patients were included in the analysis; there were 101 women (61.2%) and 64 men (38.7%). Preoperative diagnoses included nonfunctional adenoma (n = 97, 58.7%), growth hormone–secreting adenoma (n = 37, 22.4%), RCC (n = 18, 10.9%), prolactinoma (n = 8, 4.8%), and other (n = 5, 3.0%). One hundred thirty-eight patients (63.0%) had either suprasellar extension or cavernous sinus invasion. POD1 hypocortisolemia was diagnosed in 8 patients (4.8%). Of these patients, 2 (1.2%) were clinically asymptomatic and had normalized POD2 cortisol levels. Six patients (3.6%) had clinical symptoms and POD2 cortisol levels confirming HPA axis deficiency. Of these 6 patients treated with early glucocorticoid replacement, 2 patients recovered HPA axis function during follow-up, making the incidence of new, permanent HPA axis deficiency 2.5%.CONCLUSIONSIn the authors’ institutional review, all patients warranting postoperative glucocorticoid replacement had both complicated surgical courses and associated clinical symptoms of hypocortisolemia. The authors’ algorithm of withholding steroids until patients demonstrate clear evidence of postoperative hypocortisolemia is safe and clinically efficacious. Their data further suggest that routine postoperative cortisol screening may not be necessary following an uncomplicated operative resection, with gland preservation and the absence of clinical symptoms indicative of HPA dysfunction.

scholarly journals Brain neuroimaging of domestic cats: correlation between computed tomography and cross- sectional anatomy

2016 ◽  
Vol 68 (5) ◽  
pp. 1105-1111
Author(s):  
A.C. Nepomuceno ◽  
R. Zanatta ◽  
D.G. Chung ◽  
P.F. Costa ◽  
M.A.R. Feliciano ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Central Nervous System ◽  
Nervous System ◽  
Clinical Symptoms ◽  
Clinical Signs ◽  
Normal Brain ◽  
Domestic Cats ◽  
Cross Sectional ◽  
Iodinated Contrast ◽  
The Brain

ABSTRACT Computed tomography of the brain is necessary as part of the diagnosis of lesions of the central nervous system. In this study we used six domestic cats, male or female, aged between one and five years, evaluated by Computed Tomography (CT) examination without clinical signs of central nervous system disorders. Two euthanized animals stating a condition unrelated to the nervous system were incorporated into this study. The proposal consisted in establishing detailed anatomical description of tomographic images of normal brain of cats, using as reference anatomical images of cross sections of the stained brain and cranial part, with thicknesses similar to the planes of the CT images. CT examinations were performed with and without intravenous iodinated contrast media for live animals. With one euthanized animal, the brain was removed and immediately preserved in 10% formalin for later achievement in cross-sectional thickness of approximately 4mm and staining technique of Barnard, and Robert Brown. The head of another animal was disarticulated in the Atlanto-occipital region and frozen at -20ºC then sliced to a thickness of about 5mm. The description of visualized anatomical structures using tomography is useful as a guide and allows transcribing with relative accuracy the brain region affected by an injury, and thus correlating it with the clinical symptoms of the patient, providing additional information and consequent improvement to veterinarians during the course of surgical clinic in this species.

scholarly journals Analysis of the characteristics of terminal ileal ulcers: prognosis and clinical significance

2019 ◽  
Author(s):  
Liping Yang ◽  
Zhongchen Zhang ◽  
Xinxin Zhou ◽  
Chunxiao Chen
Keyword(s):  
Regression Analysis ◽  
Clinical Significance ◽  
Treatment Guidelines ◽  
Clinical Symptoms ◽  
Good Prognosis ◽  
The Other ◽  
Treatment Programs ◽  
Significant Difference ◽  
And Gender

Abstract Background Although terminal ileal ulcers can be observed occasionally in colonoscopy examination, the prognosis, clinical significance and treatment guidelines are unclear. Methods All patients diagnosed with terminal ileal ulcers from March 2014 to March 2018 were enrolled. We extracted data of gender, age, clinical symptoms, number of terminal ileal ulcers, pathological outcome, treatment programs. Results Of 42 individuals, one patient diagnosed with tuberculosis and received anti-tuberculosis treatment. The other 41 individuals chose to follow up or 5-ASA plus probiotics treatment. Logistic regression analysis showed no significant difference in treatment selection and gender (P=0.848), age (P=0.481), ulcers (p=0.116), symptoms (P=0.326). All individuals had good prognosis. Conclusion Individuals with terminal ileal ulcers have a good prognosis regardless of follow-up or treatment.

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