An update on the rod microglia variant in experimental and clinical brain injury and disease

Contemporary microglia morphologies include ramified, activated, and amoeboid, with the morphology of microglia considered highly coupled to the cellular function. Rod microglia are an additional activated microglia variant observed in the aging, injured, and diseased brain. Rod microglia were reported frequently in the early 1900’s by neuropathologists in post-mortem cases of general paresis, Alzheimer’s disease, and encephalitis, and then remained largely ignored for almost 100 years. Recent reports have renewed interest in rod microglia, most notably after experimental traumatic brain injury. Rod microglia are formed by the narrowing of the soma and retraction of planar processes, which results in the appearance of an elongated, rod-shaped cell. Rod microglia are most commonly observed in the cortex, aligned perpendicular to the dural surface adjacent to neuronal processes, and the hippocampus, aligned perpendicular to hippocampal layers. Further, rod microglia form trains with one another, apical end to basal end. By replicating the process of sketching microscopic observation, rod microglia are redefined by circumnutation around the long axis. In this update, we summarize the rod microglia variant in clinical and experimental literature and advocate for investigation into mechanisms of rod microglia origin and function.

The effect of a large dose of intravenous immunoglobulin on general paresis of the insane

General paresis of the insane (GPI) remains the form of neurosyphilis most closely associated with dementia, even after the advent of penicillin. Penicillin remains the top treatment choice for syphilis, but treatment failure is not rare. Although the neurological symptoms of GPI can be alleviated by antibiotic treatment, mental symptoms may continue. A 60-year-old man was admitted to hospital due to rapidly progressive dementia. He was diagnosed as GPI. With the patient’s informed consent, we treated him with a large dose of intravenous immunoglobulin (IVIG) (0.4 g/kg/day) for 5 days, as well as penicillin (24 million units daily divided into six doses) for 14 days. A near-immediate improvement in his emotions and orientation occurred on the 17th day in hospital. The patient made an excellent recovery 6 weeks after treatment, his psychotic and mood symptoms improved significantly. Therefore, we hypothesize that patients with GPI treated with IVIG and penicillin G would have better outcomes than those treated with penicillin G alone. IVIG may be introduced as a necessary treatment for GPI.

Neurosyphilis presenting as pure cerebellar ataxia: an atypical manifestation

Neurosyphilis has become an uncommon diagnosis in the current era. Neurological manifestations of syphilis usually lie within the spectrum of meningovascular syphilis, tabes dorsalis or general paresis of the insane. Although sensory ataxia may occur as part of spinal cord involvement, cerebellar ataxia has been rarely described as a manifestation of neurosyphilis. In this report, we describe a rare case neurosyphilis presenting in the form of a pure pancerebellar syndrome of subacute progression.

The Logic and Practice of the Prevention of Mental Disorders

This chapter discusses the history and future of prevention of mental disorders. The history of successful prevention efforts includes important disorders such as scurvy, pellagra, delirium tremens, and general paresis. The three-tiered approach of the Institute of Medicine is used (universal, selective, and indicated prevention). Successful prevention programs for the entire range of mental and behavioral disorders are reviewed at the levels of the individual, small group, family, school, workplace, community, and society. Separate sections review programs to prevent depression, schizophrenia, and cognitive decline. The Internet provides new opportunities for disseminating interventions, and integration of social, genetic, and biological predictors of mental disorders will enhance preventive efforts in the future.

Neurosyphilis and classical music: the great composers and “The Great Imitator”

ABSTRACT Throughout history, neurosyphilis has victimized many people, including classical composers, with a wide range of clinical presentations. Methods: Six articles with descriptions of composers with possible neurosyphilis were reviewed. Results: Neurosyphilis is a possible diagnosis for composers like Beethoven, whose progressive hearing loss influenced his career, culminating in complete deafness. In his autopsy, cochlear nerve atrophy and cochlear inflammation were described. Donizetti developed behavioral changes, as well as headaches, general paresis and seizures. Both Schumann and Wolf suffered from personality changes, persecutory delusions and general paresis. Joplin and Delius also had symptoms attributed to syphilis. Autopsy findings confirmed the diagnosis of Smetana, who developed dementia, deafness and auditory hallucinations with rapid progression. His tinnitus was musically represented in his first String Quartet. Conclusion: Neurosyphilis victimized several notorious composers. It can be argued that neurosyphilis was a major source of inspiration as well, being responsible for the genesis of musical masterpieces.