298 Neurosarcoidosis – review of 91 patients from three UK neuroscience centres

2018 ◽  
Vol 89 (10) ◽  
pp. A47.3-A47
Author(s):  
Farwana Reem ◽  
Murley Alex ◽  
Ankrah Lauren ◽  
Whittam Dan ◽  
Hayton Tom ◽  
...  
Keyword(s):  
Clinical Presentation ◽  
Pulmonary Sarcoidosis ◽  
Brain Parenchyma ◽  
Limb Weakness ◽  
Pooled Data ◽  
Retrospective Audit ◽  
Clinical Presentations ◽  
Radiological Changes ◽  
The Brain ◽  
Over 40 Years

BackgroundNeurosarcoidosis is a rare neuro-inflammatory disease with a wide variety of clinical presentations.MethodsRetrospective audit was conducted independently at Birmingham, Liverpool and Nottingham to identify patients with neurosarcoidosis and pooled data was analysed.Results88% of the 91 patients identified presented over 40 years of age. From the data available, 70% were White Caucasians, 21% Afro-Caribbeans and 8% were Asians. Optic neuritis (31%), limb weakness (30%), headaches (20%) and facial palsy (19%) were the most common clinical presentations with nearly a third of patients (27/91) having moderate or severe disability (modified Rankin scale ≥3) at onset. 27/58 (46.6%) of patients had raised serum ACE levels and 37/44 (84%) patients had raised CSF protein with 28/41 (68.3%) demonstrating CSF lymphocytosis (mean – 54, range 5 to 380 cells). 35/91 patients had radiological changes affecting the brain parenchyma with 23% showing leptomeningeal enhancement. 75% of the 36 patients with data available for CT chest showed evidence of pulmonary sarcoidosis. Steroids were administered in 84.9% (73/86) patients with 21 receiving steroid sparing drugs, mainly Azathioprine and Mycophenolate.ConclusionWe discuss the varied clinical presentation of neurosarcoidosis across three major UK neuroscience centres and attempt to risk stratify patients prior to immunomodulatory therapy.

scholarly journals A Case Report of Primary Brain Hydatid Cyst in a Child

2020 ◽  
Vol 6 (1) ◽  
pp. 41-48
Author(s):  
Deepak Garg ◽  
◽  
Gaurav Jain ◽  
Virendra Sinha ◽  
◽  
...  
Keyword(s):  
Hydatid Cyst ◽  
Female Child ◽  
The Body ◽  
Body Parts ◽  
Resonance Imaging ◽  
Limb Weakness ◽  
Case Presentation ◽  
Clinical Presentations ◽  
Magnetic Resonance Imaging Mri ◽  
The Brain

Background and Importance: Hydatid cyst is endemic in India, with different clinical presentations according to the site of involvement in the body. However, its occurrence in the brain without the involvement of other body parts is rare. Case Presentation: An eight-year-old female child presented with right-sided limb weakness and slurring of speech. The diagnosis of primary brain hydatid cyst was made with Magnetic Resonance Imaging (MRI) of the brain. The cyst was removed completely, resulting in improved post-operative slurring of speech and limb weakness. Conclusion: In countries where hydatid disease is endemic, brain hydatidosis should on top of the differential diagnoses for intracerebral cystic lesions and managed as per hydatid protocol until proved otherwise. This approach is critical to prevent rupture and dissemination.

Supratentorial Arachnoid Cyst Located in the Brain Parenchyma: Case Report

Neurosurgery ◽  
2011 ◽  
Vol 68 (1) ◽  
pp. E258-E262 ◽  
Author(s):  
Kyung-Jae. Park ◽  
Shin-Hyuk. Kang ◽  
Yang-Seok. Chae ◽  
Yong-Gu. Chung
Keyword(s):  
Frontal Lobe ◽  
Arachnoid Cyst ◽  
Clinical Presentation ◽  
Brain Parenchyma ◽  
Cystic Mass ◽  
Clear Fluid ◽  
Computed Tomographic ◽  
History Of ◽  
The Right ◽  
The Brain

abstract BACKGROUND AND IMPORTANCE: Arachnoid cysts have not been reported to be located within the brain parenchyma. We present a case of an arachnoid cyst that was contained entirely within the right frontal lobe devoid of communication with the subarachnoid space and ventricle. CLINICAL PRESENTATION: A 65-year-old woman presented with a 1-year history of progressive headache and nausea. Computed tomographic and magnetic resonance imagining scans showed a well-defined, nonenhancing mass measuring 5 × 5 × 3.5 cm in the right frontal lobe. The mass appeared to be contained entirely within the brain parenchyma. The patient underwent a right frontal craniotomy, at which time the cystic mass was identified in the brain parenchyma without any communication with the arachnoid space. The cyst contained a clear fluid, and its wall was excised. The fluid contents demonstrated a composition similar to that of normal cerebrospinal fluid. Histological and immunohistochemical examinations of the cyst wall were compatible with the diagnosis of an arachnoid cyst. Postoperatively, the symptoms of the patient resolved, and no recurrence was observed up to 6 months after removal. CONCLUSION: The present case showed an intraparenchymal arachnoid cyst arising in the frontal lobe. Although the etiology is not known, an arachnoid cyst should be included in the differential diagnosis of primary intracerebral cysts.

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.

Medullary abscess: a rare clinical presentation

2020 ◽  
Vol 13 (3) ◽  
pp. e233286
Author(s):  
Pavels Muranovs ◽  
Claire Gillon ◽  
John Norris
Keyword(s):  
Clinical Presentation ◽  
Rapid Onset ◽  
Brain Parenchyma ◽  
Causative Organism ◽  
Dental Infection ◽  
Medical Practitioners ◽  
Brain Abscesses ◽  
The Brain ◽  
Prompt Diagnosis ◽  
Early Surgical Intervention

Brain abscesses represent areas of localised infection of the brain parenchyma. Those confined to the brainstem are rare and usually fatal if untreated. Streptococcus intermedius is a common causative organism of brain abscesses and is associated with significant morbidity. We describe a case report of medullary abscess secondary to dental infection in a 68-year-old patient. The patient presented with headaches and flu-like symptoms progressing to left hemiparesis and reduced consciousness/bulbar function. The patient underwent emergency posterior fossa craniectomy and drainage with subsequent medical management with antibiotics. Prompt diagnosis, early surgical intervention and maximal therapy with antibiotics alongside extensive rehabilitation are all vital to ensure good neurological outcome. It is imperative for medical practitioners to consider the diagnosis of brain abscess in patients presenting with rapid onset neurological deterioration. Such cases require early neurological imaging with involvement of tertiary neurosurgery services.

scholarly journals Brain abscess: Current management

2013 ◽  
Vol 04 (S 01) ◽  
pp. S67-S81 ◽  
Author(s):  
Hernando Alvis Miranda ◽  
Sandra Milena Castellar Leones ◽  
Mohammed Awad Elzain ◽  
Luis Rafael Moscote-Salazar
Keyword(s):  
Clinical Outcomes ◽  
Brain Abscess ◽  
Clinical Presentation ◽  
Epidural Abscess ◽  
Brain Parenchyma ◽  
Surgical Skills ◽  
Current Management ◽  
Brain Infection ◽  
Focal Infection ◽  
The Brain

ABSTRACTBrain abscess (BA) is defined as a focal infection within the brain parenchyma, which starts as a localized area of cerebritis, which is subsequently converted into a collection of pus within a well?vascularized capsule. BA must be differentiated from parameningeal infections, including epidural abscess and subdural empyema. The BA is a challenge for the neurosurgeon because it is needed good clinical, pharmacological, and surgical skills for providing good clinical outcomes and prognosis to BA patients. Considered an infrequent brain infection, BA could be a devastator entity that easily left the patient into dead. The aim of this work is to review the current concepts regarding epidemiology, pathophysiology, etiology, clinical presentation, diagnosis, and management of BA.

A Case of Neurosarcoidosis Mimicking Brain Tumor

2020 ◽  
Vol 16 ◽  
Author(s):  
Lutfullah Sari ◽  
Abdusselim Adil Peker ◽  
Dilek Hacer Cesme ◽  
Alpay Alkan
Keyword(s):  
Brain Tumor ◽  
Contrast Enhancement ◽  
Clinical Laboratory ◽  
Vasogenic Edema ◽  
Pulmonary Sarcoidosis ◽  
Brain Parenchyma ◽  
The Body ◽  
Oligoclonal Bands ◽  
Flair Sequence ◽  
History Of

Background: Neurosarcoidosis manifests symptomatically in 5% of patients with sarcoidosis and diagnosis can be challenging if not clinically suspected. Cerebral mass-like presentation of neurosarcoidosis rarely reported in the literature. We presented a woman with neurosarcoidosis who had a cerebral mass-like lesion which completely disappeared after medical treatment. Discussion: A 37-year-old woman with history of pulmonary sarcoidosis referred to the emergency service of our hospital with a one-month history of progressive dizziness, nausea and seeing flashing lights. At neurologic examination, numbness and weakness on the left side of the body, deviation of uvula toward the right side was seen. Cranial MRI demonstrated a 2.5x2 cm in size mass lesion which hypointense on T1 WI, heterogeneous hyperintense on T2 and FLAIR sequence with peripheral vasogenic edema and heterogeneous, irregular contrast enhancement simulating brain tumor. Also, leptomeningeal and nodular contrast enhancement was seen on brainstem, cerebellar vermis, perimesencephalic cistern and left frontal, bilateral parietooccipital sulcus. In laboratory tests; The level of serum angiotensin-converting enzyme (ACE) was 53 IU/mL (N:8-52 IU/mL) and cerebrospinal fluid (CSF) ACE was 23 IU/mL (N:0-2.6 IU/mL). CSF cytology analysis was normal. Pattern 2 oligoclonal bands were present. With these clinical, laboratory and radiological findings, cerebral involvement of sarcoidosis was suspected. Biopsy was not performed due to the high risk of morbidity caused by the deep location of the lesion.Patient was treated with methylprednisolone and Azathioprine for a month.On post-treatment control imaging; lesion disappeared completely without residual leptomeningeal and nodular contrast enhancement.Also, neurologic symptoms were decreased remarkably. Conclusion: Multi-system inflammatory disorders like sarcoidosis, can present with mass-like lesion in the brain parenchyma. While early diagnosis is important to prevent unnecessary interventions like biopsy and surgery, it is crucial to initiate the necessary treatment with the aim of recovery without sequelae. Radiological and clinical follow-up are fundamental in differential diagnosis.

scholarly journals Mechanisms of Neurodegeneration in Various Forms of Parkinsonism—Similarities and Differences

Cells ◽  
2021 ◽  
Vol 10 (3) ◽  
pp. 656
Author(s):  
Dariusz Koziorowski ◽  
Monika Figura ◽  
Łukasz M. Milanowski ◽  
Stanisław Szlufik ◽  
Piotr Alster ◽  
...  
Keyword(s):  
Neurodegenerative Diseases ◽  
Tau Protein ◽  
Protein Gene ◽  
Clinical Presentation ◽  
Neuronal Loss ◽  
Corticobasal Degeneration ◽  
Inflammatory Factors ◽  
Parkinsonian Disorders ◽  
Genetic Features ◽  
The Brain

Parkinson's disease (PD), dementia with Lewy body (DLB), progressive supranuclear palsy (PSP), corticobasal degeneration (CBD) and multiple system atrophy (MSA) belong to a group of neurodegenerative diseases called parkinsonian syndromes. They share several clinical, neuropathological and genetic features. Neurodegenerative diseases are characterized by the progressive dysfunction of specific populations of neurons, determining clinical presentation. Neuronal loss is associated with extra- and intracellular accumulation of misfolded proteins. The parkinsonian diseases affect distinct areas of the brain. PD and MSA belong to a group of synucleinopathies that are characterized by the presence of fibrillary aggregates of α-synuclein protein in the cytoplasm of selected populations of neurons and glial cells. PSP is a tauopathy associated with the pathological aggregation of the microtubule associated tau protein. Although PD is common in the world's aging population and has been extensively studied, the exact mechanisms of the neurodegeneration are still not fully understood. Growing evidence indicates that parkinsonian disorders to some extent share a genetic background, with two key components identified so far: the microtubule associated tau protein gene (MAPT) and the α-synuclein gene (SNCA). The main pathways of parkinsonian neurodegeneration described in the literature are the protein and mitochondrial pathways. The factors that lead to neurodegeneration are primarily environmental toxins, inflammatory factors, oxidative stress and traumatic brain injury.

1001 Intra-Articular Distal Radius Fracture Surgical Intervention Threshold Origins and Development

2021 ◽  
Vol 108 (Supplement_2) ◽  
Author(s):  
G Esworthy ◽  
N Johnson ◽  
J Dias ◽  
P Divall
Keyword(s):  
Distal Radius ◽  
Clinical Presentation ◽  
Surgical Intervention ◽  
Threshold Value ◽  
British Society ◽  
Relevant Today ◽  
Clinical Presentations ◽  
Post Traumatic ◽  
Current Guidance ◽  
Traumatic Arthritis

Abstract Background Treatment of intra-articular distal radius fractures is guided by the displacement of the articular fragments. Symptomatic post-traumatic arthritis is expected to occur if step displacement is > 2mm; this value is often used as an indication for surgery if closed reduction is not possible. Method A systematic review was performed to establish the origin and adaptations of the threshold, with papers screened and relevant citations reviewed. Orthopaedic textbooks were reviewed to ensure no earlier mention of the threshold was present. Results Knirk and Jupiter, 1986, are the first to quantify a threshold, with all their patients developing arthritis with >2mm displacement. Some papers have discussed using 1mm, although 2mm is most widely reported. Current guidance from the British Society for Surgery of the Hand supports 2mm. Although this paper is still widely cited, the authors published a re-examination of the data showing methodological flaws which is not as widely reported. They claim their conclusions are still relevant today; however, the radiological arthritis does not correlate with the clinical presentation. Conclusions Knirk and Jupiter originated the threshold value of 2mm. The lack of correlation between the radiological and clinical presentations warrants further investigation. The principle of treatment remains restoration of normal anatomical position.

scholarly journals Macrophages and microglia: the cerberus of glioblastoma

2021 ◽  
Vol 9 (1) ◽  
Author(s):  
Alice Buonfiglioli ◽  
Dolores Hambardzumyan
Keyword(s):  
Tumor Cells ◽  
Innate Immune System ◽  
Tumor Heterogeneity ◽  
Expression Profiles ◽  
Brain Parenchyma ◽  
Innate Immune ◽  
Malignant Growth ◽  
Neoplastic Cells ◽  
Functional Roles ◽  
The Brain

AbstractGlioblastoma (GBM) is the most aggressive and deadliest of the primary brain tumors, characterized by malignant growth, invasion into the brain parenchyma, and resistance to therapy. GBM is a heterogeneous disease characterized by high degrees of both inter- and intra-tumor heterogeneity. Another layer of complexity arises from the unique brain microenvironment in which GBM develops and grows. The GBM microenvironment consists of neoplastic and non-neoplastic cells. The most abundant non-neoplastic cells are those of the innate immune system, called tumor-associated macrophages (TAMs). TAMs constitute up to 40% of the tumor mass and consist of both brain-resident microglia and bone marrow-derived myeloid cells from the periphery. Although genetically stable, TAMs can change their expression profiles based upon the signals that they receive from tumor cells; therefore, heterogeneity in GBM creates heterogeneity in TAMs. By interacting with tumor cells and with the other non-neoplastic cells in the tumor microenvironment, TAMs promote tumor progression. Here, we review the origin, heterogeneity, and functional roles of TAMs. In addition, we discuss the prospects of therapeutically targeting TAMs alone or in combination with standard or newly-emerging GBM targeting therapies.

scholarly journals Practical application of synthetic head models in real ballistic cases

2021 ◽  
Author(s):  
F. Riva ◽  
T. Fracasso ◽  
A. Guerra ◽  
P. Genet
Keyword(s):  
Soft Tissues ◽  
Spherical Model ◽  
Brain Parenchyma ◽  
Human Bone ◽  
Shape Model ◽  
The Difference ◽  
Open Shape ◽  
The Brain ◽  
Synthetic Models ◽  
Representative Material

AbstractIn shooting crimes, ballistics tests are often recommended in order to reproduce the wound characteristics of the involved persons. For this purpose, several “simulants” can be used. However, despite the efforts in the research of “surrogates” in the field of forensic ballistic, the development of synthetic models needs still to be improved through a validation process based on specific real caseworks. This study has been triggered by the findings observed during the autopsy performed on two victims killed in the same shooting incident, with similar wounding characteristics; namely two retained head shots with ricochet against the interior wall of the skull; both projectiles have been recovered during the autopsies after migration in the brain parenchyma. The thickness of the different tissues and structures along the bullets trajectories as well as the incident angles between the bullets paths and the skull walls have been measured and reproduced during the assemblage of the synthetic head models. Two different types of models (“open shape” and “spherical”) have been assembled using leather, polyurethane and gelatine to simulate respectively skin, bone and soft tissues. Six shots have been performed in total. The results of the models have been compared to the findings of post-mortem computed tomography (PMCT) and the autopsy findings.Out of the six shots, two perforated the models and four were retained. When the projectile was retained, the use of both models allowed reproducing the wounds characteristics observed on both victims in terms of penetration and ricochet behaviour. However, the projectiles recovered from the models showed less deformation than the bullets collected during the autopsies. The “open shape” model allowed a better controlling on the shooting parameters than the “spherical” model. Finally, the difference in bullet deformation could be caused by the choice of the bone simulant, which might under-represent either the strength or the density of the human bone. In our opinion, it would be worth to develop a new, more representative material for ballistic which simulates the human bone.

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