Spontaneous Intracranial Hypotension Without CSF Leakage—Concept of a Pathological Cranial to Spinal Fluid Shift

Objective: Spontaneous intracranial hypotension (SIH) is typically caused by CSF leakage from a spinal dural tear, a meningeal diverticulum, or a CSF venous fistula. However, some patients present with classic orthostatic symptoms and typical intracranial imaging findings without evidence of CSF leakage despite repeated diagnostic work-up. This article aims to elaborate a hypothesis that would explain a pathologically increased orthostatic shift of CSF from the cranial to the spinal compartment in the absence of a CSF leak.Medical Hypothesis: The symptoms of SIH are caused by a decrease in intracranial CSF volume, intracranial hypotension, and downward displacement of intracranial structures. A combination of pathologically increased spinal compliance, decreased intracranial CSF volume, low CSF outflow resistance, and decreased venous pressure might result in a pathological orthostatic cranial-to-spinal CSF shift. Thus, in rare cases, intracranial hypotension may occur in the absence of CSF leakage from the dural sac.Conclusion: We propose a pathophysiological concept for the subgroup of SIH patients with typical cranial imaging findings and no evidence of CSF leakage. In these patients, reducing the compliance or the volume of the spinal compartment seems to be the appropriate therapeutic strategy.

Inference and Inductive Risk

Several types of inferences are common in the diagnosis and prognosis of brain injuries. These inferences, although necessary, introduce epistemic uncertainty. This chapter details the various inferences and considers the concept of inductive risk, introduced by Richard Rudner in the 1950s, and the problem of inductive risk: given uncertainty, what is the appropriate epistemic standard of evidence for accepting a scientific (or medical) hypothesis? Two principles of inductive risk are proposed to tackle the problem of inductive risk present in disorders of consciousness (and other medical contexts): the First Principle calls on us to index epistemic risk-taking to the level of ethical risk, thus constraining acceptable epistemic risk-taking. The Second Principle tells us to index ethical risk-taking to the level of epistemic risk, thus constraining ethical risk-taking to a level commensurate with epistemic uncertainty.

Rapid amelioration of anorexia nervosa in a male adolescent during metreleptin treatment including recovery from hypogonadotropic hypogonadism

With this case report we support our medical hypothesis that metreleptin treatment ameliorates starvation related emotional, cognitive and behavioral symptomatology of anorexia nervosa (AN) and show for the first time strong effects in a male patient with AN. A 15.9 year old adolescent with severe AN of eight-month duration was treated off-label with metreleptin. Hyperactivity was assessed with accelerometry. Visual analogue scales (VAS), validated self- and clinician rating scales and lab results tracked changes from baseline to end of the 24-day dosing period and a five-month follow-up. Substantial improvements of mood and eating disorder related cognitions and hyperactivity set in after two days of treatment. During dosing, sub-physiological testosterone and TT3 levels normalized; clinically libido reemerged. Weight did not increase substantially during the dosing period. During follow-up target weight was attained; mood did not deteriorate; hyperactivity ceased. The results substantiate the strong effects seen in female cases and underscore the need for a double-blind placebo-controlled trial to confirm the observed strong, multiple and rapid onset beneficial effects of metreleptin in AN.

The role of neurological involvement in malignant tissues: architecture deterioration as a new medical hypothesis explaining cancer progression

In this study, we reported our previous observations and perceptions regarding the involvement of neurological components in the malignant tissues. We used to examine different tissues with malignancy, and we observed increased involvement of neurological components as peripheral nerves. At the beginning, no plausible explanation to such phenomenon. Later, we showed in diabetic rat model that white matter was involved in diabetic progression through the up-regulation of inducible nitric oxide synthase (iNOS) and the down-regulation of heat shock protein70 (HSP70). We extended our investigations in other organs in the same model including kidney, liver, testes, and prostate. We found the same phenomenon of the expression of iNOS and HSP70 in the tissues of these organs. We also observed that there was a deterioration of tissue architecture due to diabetic effects. We think that this deterioration may result from the neurological involvement in these tissues. However, because diabetes may result in initiation of some tumors such as endometrium cancer, deterioration of tissue architecture and neurological involvement are becoming more importantly. This study aimed to introduce our hypothesis in this issue “Architecture deterioration as a new medical hypothesis explaining cancer progression”. We also reviewed the relevant literature.

End-to-End AI-Based Point-of-Care Diagnosis System for Classifying Respiratory Illnesses and Early Detection of COVID-19: A Theoretical Framework

Respiratory symptoms can be caused by different underlying conditions, and are often caused by viral infections, such as Influenza-like illnesses or other emerging viruses like the Coronavirus. These respiratory viruses, often, have common symptoms: coughing, high temperature, congested nose, and difficulty breathing. However, early diagnosis of the type of the virus, can be crucial, especially in cases, such as the COVID-19 pandemic. Among the factors that contributed to the spread of the COVID-19 pandemic were the late diagnosis or misinterpretation of COVID-19 symptoms as regular flu-like symptoms. Research has shown that one of the possible differentiators of the underlying causes of different respiratory diseases could be the cough sound, which comes in different types and forms. A reliable lab-free tool for early and accurate diagnosis, which can differentiate between different respiratory diseases is therefore very much needed, particularly during the current pandemic. This concept paper discusses a medical hypothesis of an end-to-end portable system that can record data from patients with symptoms, including coughs (voluntary or involuntary) and translate them into health data for diagnosis, and with the aid of machine learning, classify them into different respiratory illnesses, including COVID-19. With the ongoing efforts to stop the spread of the COVID-19 disease everywhere today, and against similar diseases in the future, our proposed low cost and user-friendly theoretical solution could play an important part in the early diagnosis.

Treatment of patients with advanced diabetes type 2 and hypertension without the use of conventional treatment is possible: white matter alterations and treatment of diabetes and hypertnsion as a new medical hypothesis

Diabetes has been described for 3500 years. Therapeutic options vary but they involve giving insulin or lowering glucose such as metformin. The objective of this study was to report how diabetes type 2 and hypertension can be treated successfully without using the diabetes conventional treatments. A 50 years male with high glucose level (330 mg/dl), HBA1c (9.6%). Blood profile was altered. Hypertension was elevated (145/100) mm hg. The patient expressed his tension and desire not to commit conventional diabetic and hypertension treatment and asked for other therapeutic alternatives. Based on our experience, we recommended him to use two spoon of ground Urtica pilulifera (U. p)/ day, and to use two capsules of Ammi visnaga (A.V) following each meal. Further, the patient followed the dietary restrictions by replacing white bread with a spoon and followed some exercise programs by walking for 30 minutes a day. The results of this program were shown as continuous lowering blood glucose to the level of 117 mg/dl, and blood pressure was 123/79 after 5 days. Taken together, both diabetes type 2 and hypertension can be successfully treated naturally

Insulin as a predictor of diabetes type 2: a new medical hypothesis

Since the discovery of diabetes, it is about insulin production, or function. In this study, we may introduce a controversial concept. Insulin as a predictor of diabetes, in other words, insulin can cause diabetes type 2. We think that this could serve as a new medical hypothesis. To examine this hypothesis, we analyzed dataset posted in Kaggle from India. The dataset included 763 female patients of whom 497 had no diabetes, and 266 with type 2 diabetes. We used routine statistical analysis and neural network analysis. The results showed that insulin level increases as the diabetes is progressed, and its relative contribution to diabetes was estimated as 28.4%. Taken together, insulin measurement is recommended to be considered in the management of diabetes.

Medical Hypothesis: Deep Brain Stimulation for Intractable Migraine

Deep Brain Stimulation (DBS) has been introduced as an innovative treatment for several neurological disorders, including Parkinson’s disease, essential tremor, and dystonia and it has been proven effective in helping individuals affected by these disorders; hence, enhancing their quality of life. DBS has also been investigated for the treatment of cluster and other primary headaches. Electrodes are surgically implanted into brain structures, for example the posterior hypothalamus in case of cluster headache. Hypothalamic DBS has been successfully used to treat patients with cluster headache and short-lasting unilateral neuralgiform headache with conjunctival injection and tearing (SUNCT). In these headache conditions, DBS may reduce headache frequency by half, however, some side effects have also been reported that are mainly related to infection where the electrodes are placed, syncope, and diplopia. Hypothalamic DBS is proposed to modulate neuronal structures that are directly or indirectly involved in detection or transmission of painful stimuli or in the processing of this information. Reports of the use of DBS for chronic migraine are not found in the literature. This commentary explores the medical hypothesis that DBS could be considered as a therapeutic option for intractable chronic migraine. This hypothesis is based on the commonalities between cluster headache and migraine in terms of some shared symptoms, and potential overlap of underlying mechanisms. However, due to the absence of clinical evidence supporting the use of DBS in CM, the fact that disease-specific optimization of DBS parameters must be considered carefully, and considering the optimal CNS structures to target are currently unknown, it is concluded that this interventional and invasive technique should be avoided for CM for the present time.