Adenoid cystic carcinoma with a leptomeningeal dissemination in a ‘wash’ pattern

A 39-year-old woman was referred to the neurology department due to headache, instability and difficulty walking for 5 months. Several ancillary tests were performed. The blood test showed leucocytosis and the cerebrospinal fluid revealed an increased total protein and glucose consumption. Other infections or autoimmune causes were excluded. The MRI showed non-specific brain and spinal cord lesions. Given the findings described, a differential diagnosis between granulomatous meningoencephalitis and primary tumour or metastasis was proposed. Empirical treatment with tuberculostatic agents and corticosteroids was started. The neurological state of the patient worsened, she fell into a non-responsive coma and died in few days. The clinical autopsy performed revealed an adenoid cystic carcinoma with involvement of the central nervous system that developed leptomeningeal dissemination along the spinal cord in a fluid ‘wash’ pattern.

Information Flow Pattern in Early Mild Cognitive Impairment Patients

Purpose: To investigate the brain information flow pattern in patients with early mild cognitive impairment (EMCI) and explore its potential ability of differentiation and prediction for EMCI.Methods: In this study, 49 patients with EMCI and 40 age- and sex-matched healthy controls (HCs) with available resting-state functional MRI images and neurological measures [including the neuropsychological evaluation and cerebrospinal fluid (CSF) biomarkers] were included from the Alzheimer's Disease Neuroimaging Initiative. Functional MRI measures including preferred information flow direction between brain regions and preferred information flow index of each brain region parcellated by the Atlas of Intrinsic Connectivity of Homotopic Areas (AICHA) were calculated by using non-parametric multiplicative regression-Granger causality analysis (NPMR-GCA). Edge- and node-wise Student's t-test was conducted for between-group comparison. Support vector classification was performed to differentiate EMCI from HC. The least absolute shrinkage and selection operator (lasso) regression were used to evaluate the predictive ability of information flow measures for the neurological state.Results: Compared to HC, disturbed preferred information flow directions between brain regions involving default mode network (DMN), executive control network (ECN), somatomotor network (SMN), and visual network (VN) were observed in patients with EMCI. An altered preferred information flow index in several brain regions (including the thalamus, posterior cingulate, and precentral gyrus) was also observed. Classification accuracy of 80% for differentiating patients with EMCI from HC was achieved by using the preferred information flow directions. The preferred information flow directions have a good ability to predict memory and executive function, level of amyloid β, tau protein, and phosphorylated tau protein with the high Pearson's correlation coefficients (r > 0.7) between predictive and actual neurological measures.Conclusion: Patients with EMCI were presented with a disturbed brain information flow pattern, which could help clinicians to identify patients with EMCI and assess their neurological state.

Minimal Invasive Fluoroscopic Percutaneous Lateral Stabilization of Thoracolumbar Spinal Fractures and Luxations Using Unilateral Uniplanar External Skeletal Fixators in Dogs and Cats

Objective The aim of this study was to describe minimally invasive spinal stabilization using a unilateral uniplanar external skeletal fixator (ESF, type 1a) with polymethylmethacrylate, and to review short- and long-term outcomes and complications in a clinical case series. Materials and Methods Medical records from animals affected by spinal fracture luxation were reviewed. The data included breed, age, gender, body weight, aetiology, preoperative and postoperative neurological state, radiographic findings, surgical treatment, pin size, number of pins and stabilized vertebrae, intra- and postoperative complications and neurological state at re-examinations. Results Thirty-two animals were identified; three were treated conservatively, 19 surgically and 10 were euthanatized. In eight dogs and six cats, the injured spinal column was treated with a laterally applied percutaneous type 1a ESF under fluoroscopic guidance. Positive profile end-threaded pins inserted were from 1.6/1.9 to 3.5/4.3 mm in dogs and 1.6/1.9 to 2/2.3 mm in cats and were placed into two to five vertebral bodies. At the re-examinations, the neurological status had improved in 12 animals, deteriorated in one, and was unchanged in another one. In eight cases, no complications were detected. The most common complications included erythema, exudation and pin loosening. Conclusion The present work shows that type 1a ESF can be successfully and minimally invasively applied to fractures and luxations of the spine in dogs and cats with minimal major complications.

Benefits of glioma resection in the corpus callosum

Due to anticipated postoperative neuropsychological sequelae, patients with gliomas infiltrating the corpus callosum rarely undergo tumor resection and mostly present in a poor neurological state. We aimed at investigating the benefit of glioma resection in the corpus callosum, hypothesizing neuropsychological deficits were mainly caused by tumor presence. Between 01/2017 and 1/2020, 21 patients who underwent glioma resection in the corpus callosum were prospectively enrolled into this study. Neuropsychological function was assessed preoperatively, before discharge and after 6 months. Gross total tumor resection was possible in 15 patients, and in 6 patients subtotal tumor resection with a tumor reduction of 97.7% could be achieved. During a median observation time of 12.6 months 9 patients died from glioblastoma after a median of 17 months. Preoperatively, all cognitive domains were affected in up to two thirds of patients, who presented a median KPS of 100% (range 60–100%). After surgery, the proportion of impaired patients increased in all neurocognitive domains. Most interestingly, after 6 months, significantly fewer patients showed impairments in attention, executive functioning, memory and depression, which are domains considered crucial for everyday functionality. Thus, the results of our study strongly support our hypothesis that in patients with gliomas infiltrating the corpus callosum the benefit of tumor resection might outweigh morbidity.

P1528EPIDEMIOLOGICAL SURVEY OF A POPULATION UNDERGOING URGENT HEMODIALYSIS

Background and Aims Urgent hemodialysis is a very common situation in nephrology and is burdened with high morbidity and mortality. The aim of this work is to study the epidemiological, etiological, clinico-biological and indications of dialysis emergencies, the parameters of the session and the potential complications. Method This is a descriptive study conducted over a period of 12 months (January – December 2017), including all patients who have been admitted to the nephrology department for urgent management in hemodialysis. Results Our study collected a total of 318 patients (sex ratio =1.52), the mean age 60.54 ± [18-95 years]. Patients came mainly from the emergency department (69.8%). 40.9 % of the patients were diabetic and 66,4 % hypertensive, 15.1% had coronary artery disease. Among patients, 80.9% had chronic renal insufficiency, of which 29.6% were end-stage (28% hemodialysis and 1.6% peritoneal dialysis). Urgent hemodialysis was undertaken for threatening hyperkalemia in 58.2% of cases, a poorly tolerated uremic syndrome in 50.8% acute pulmonary edema (APO) in 36.5% of cases, and anuria greater than 12h were the indication in 44.4% of cases and a severe metabolic acidosis in 11.3% of cases. The average duration of the session was 3 hours. Ultrafiltration was necessary in 63.7% of the cases. The blood access was a femoral catheter in 80.6% of the cases. Blood transfusion was indicated in 13.8% of cases. Main complications were dominated by symptomatic arterial hypotension in 12.9% requiring stopping the session in half of cases hypoglycemia in 6.9%, neurological disorder in 6.6% chest pain in 3.5 %. After a year of follow up care, overall mortality was 40% in this population. On multivariate analysis, age (p=0.006) and neurological state according to the glasgow score (p=0.01) were retained as independent factors of mortality in this population. Conclusion A greater prevalence of urgent hemodialysis is observed in our country testifying to the accessibility of this method of extrarenal replacement. Hyperkalemia, uremic syndrom and PAO are the main indications for urgent hemodialysis. Early diagnosis, prompt and relevant management of these patients will determine their prognoses in the short and medium term.

Migraine as the First Symptom for Setting a Clinical Diagnosis

The migraine is among the most frequent complains of the patients requesting a medical consultation. I am presenting hereby the case of a 34-year old patient, who complained of diffuse migraine followed several weeks later by vomiting and seizures. The brain computed tomography (CT) and magnetic resonance imaging (MRI) examinations indicate an intracranial spread located in the left (temporal) hemisphere, which had a mass effect on the ventricular system. When performing the extemporaneous examination, it was found an anaplastic oligodendroglioma. Subtotal resection under microscopic guidance was performed, as well as radiotherapy and chemotherapy after the surgery. When discharged from hospital, the patient was surgically cured and had an improved neurological state. The repeated checkups (clinical and paraclinical) indicated no signs of local relapse. Approximately 8 years after the first surgery, the patient returned for a check-up, in view of investigations and treatment, while complaining of migraine and a nervousness state that was bothering his family. The brain MRI indicated a large tumour relapse located in the left temporal-hippocampal region. The histopathology examination indicated that it was an anaplastic oligodendroglioma relapse. Surgery was performed and the tumour relapse located in the left temporal-hippocampal region was completely ablated. After the surgery, the patient was conscious and had no movement dysfunctions.

Features of the chemokine profile of blood plasma by neurotoxic complications of acute lymphoblastic leukemia in children: preliminary report

The article presents an assessment of the neurotoxicity of chemotherapy in children with acute lymphoblastic leukemia receiving specific treatment according to the protocols used in pediatric oncological practice. An analysis of the neurological state with the determination of the chemokine profile of blood plasma was performed in 21 children aged 3 to 17 at the Regional Children’s Clinical Hospital in Yekaterinburg and the Central Research Laboratory of the Ural State Medical University in 2019. In the study group of children, neurotoxic complications were recorded in 42.9% of cases. At the same time, the appearance of neurological symptoms in most patients (77.7%) was observed during co chemotherapy at the stages of reinduction during consolidating treatment with a predominant clinical picture of chemo-induced polyneuropathy. In a comparative analysis of the indicators of the chemokine profile in groups of children, depending on the formation of neurotoxic complications during chemotherapy, we selected the chemokines CXCL10 (IP-10) and CXCL12 (SDF-1α) as possible prognostic biomarkers of damage to the nervous system.