Nucleus accumbens stereotactic surgery: Achieving accuracy through area M

The nucleus accumbens (NA), a major pleasure center of the human brain, is a limbic-motor interface involved in several neurological and psychiatric disorders. During the last decade, this nucleus is also a deep brain stimulation target for selected patients. Purpose of this paper is to comment on the article entitled “Stereotactic anatomy of the human nucleus accumbens: from applied mathematics to microsurgical accuracy” which was recently published in “Surgical and Radiologic Anatomy” and is one of the latest articles on NA anatomy and surgery. The described results included a probability-based guide for in vivo (side-depended) stereotactic localization of the human NA and a standard for the NA, specific stereotactic zone of the human brain (which can be used in combination for an accurate stereotactic NA targeting). Furthermore, two specific stereotactically standard NA areas were found which could be used as abundant stereotactic guides for targeting of the anterior limb of the internal capsule, with electrode’s contact 0 (lowest) placed in the vicinity of the NA. However, the most important finding of this paper was standard area M (Mavridis’ area), which is the most reliable stereotactically standard area of the human NA, regardless of side or gender, useful for highly accurate stereotactic NA targeting.

Anterior communicating artery aneurysm associated with duplicated hypoplastic right A1 segment

Variations of the anterior cerebral artery (ACA)-anterior communicating artery (ACoA) complex are commonly observed when associated with a symptomatic intracranial aneurysm. We report an asymptomatic ACoA aneurysm associated with duplicated hypoplastic A1 segment of the right ACA, observed in a 70-year-old female cadaver. Furthermore, the aneurysm, practically substituting the ACoA, caused a remarkable depression on the internal surface of the right frontal lobe, anterior to the optic chiasm. Aneurysms and other anomalies of the ACA and ACoA are common and their microvascular surgical management requires sound knowledge of the normal and variant vascular anatomy. Persistence of some embryonic vessels that normally disappear, disappearance of vessels that would normally persist or sprouting of new vessels due to hemodynamic and genetic factors are the usual causes for such anomalies. The high incidence of coexisting vascular anomalies and aneurysm suggests that such abnormalities predispose to aneurysm formation due to changes in the regional blood flow. A1 segment duplication has been reported to occur in 4% of subjects in cadaveric studies and in up to 0.5%-9.7% of cases of ACoA aneurysm surgery. Angiographic hypoplasias and aplasias of the A1 segment have been also correlated with ACoA aneurysm patients.

Hashimoto’s encephalopathy presenting as acute cognitive decline in an elderly male

Hashimoto’s encephalopathy (HE) is a rare form of reversible encephalopathy characterized by the presence of anti-thyroid antibodies in serum and/or cerebrospinal fluid. The syndrome is more common in women and the presentation varies considerably. Here, we report a case of an elderly male with a history of Hashimoto’s thyroiditis, presenting with acute cognitive decline. A diagnosis of HE was established based on the presence of anti-thyroid antibodies in the serum, diffuse electroencephalography changes and lack of an alternative explanation. The patient promptly responded to steroids and was discharged on the 8^th day of admission. We suggest that an assessment of thyroid antibodies should be included in anyone presenting with acute cognitive decline in the absence of alternative explanation.

Depression in adults with epilepsy: Relationship to psychobiological variables

AIM: To characterize the relationship between depression and epilepsy-related seizures, treatment, hormonal and biological variables.

METHODS: Included were 200 Egyptian adults (male = 100, female = 100) with epilepsy (mean age: 30.87 ± 7.88 years; duration of illness: 13.89 ± 7.64 years) and 100 healthy matched subjects for comparison. Psychiatric interview, Beck Depression Inventory (BDI-II) and Hamilton Anxiety Rating Scale (HAM-A) were used to assess depression and anxiety. Blood levels of free testosterone, sex hormone binding globulin, prolactin, free thyroxin and thyroid stimulating hormone, serotonin, noradrenaline and adrenaline neurotransmitters were measured to assess endocrine and biological states.

RESULTS: Patients had higher rates of depressive disorder (25.5% or 51/200), mostly intermixed with anxiety (47.06%), psychotic features (19.61%), aggression (40%) and suicide (55%). Compared to controls, higher scores on the BDI-II were observed with right-sided epileptic foci (P = 0.011), polytherapy (P = 0.001) and lack of control on antiepileptic drugs (AEDs) (P = 0.0001). Patients had lower levels of serotonin (P = 0.001) [marked with depression (P = 0.012)] and adrenaline (P = 0.0001), while noradrenaline was lower with temporal lobe epilepsy (P = 0.039), left-sided foci (P = 0.047) and lack of control on AEDs (P = 0.017). Negative correlations were observed between levels of serotonin and BDI-II (P = 0.048) and HAM-A (P = 0.009) scores, but not with AEDs dose or drug level.

CONCLUSION: Comorbid depressive disorder with epilepsy appears to be closely related to seizure type, focus, side, intractability to medications and neurotransmitter changes. Thus, optimizing seizure control and early recognition and management of depression is necessary to improve patients’ quality of life.

What is the purpose of launching World Journal of Neurology?

The first issue of World Journal of Neurology, a bimonthly peer-reviewed, online, open-access journal will be published on December 28, 2011. The preparatory work for this journal was initiated on December 5, 2010. The WJN Editorial Board has now been established and consists of 100 members who are distinguished, world-renowned experts in neurology and related specialties (psychiatry, geriatric medicine, and internal medicine) from 30 countries. Our purpose in launching WJN is to publish peer-reviewed, high-quality articles via an open-access online publishing model. In this context, a multidisciplinary journal such as WJN may serve as a unique and useful platform for updated ”review”, “mini-review” and ”experimental” articles in neurological and psychiatric age-related research that would eventually help promote healthy lives in both adult and older individuals.