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White TG, Turpin J, Shao M, Bassett JB, Baris C, Libman RB, Patsalides A. Cerebrospinal fluid venous fistula causing spontaneous intracranial hypotension resulting in venous sinus thrombosis and coma. Interv Neuroradiol 2024:15910199241272582. [PMID: 39175457 DOI: 10.1177/15910199241272582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/24/2024] Open
Abstract
Cerebrospinal fluid (CSF) fistulas have recently been recognized as a cause of spontaneous intracranial hypotension (SIH), predominantly presenting with headaches, especially positional headaches. Atypical presentations like tinnitus and cranial nerve symptoms have also been reported. SIH has been linked to venous sinus thrombosis; however, to our knowledge, no prior cases describe a CSF venous fistula causing SIH that leads to cerebral venous thrombosis and coma. We report a patient who developed progressive venous sinus thrombosis, leading to coma, and was found to have low intracranial pressure indicative of SIH. Invasive monitoring and imaging confirmed the low intracranial pressure, prompting a dynamic myelogram that revealed a T2/3 CSF venous fistula. The patient underwent transvenous embolization of the fistula, which resulted in the resolution of symptoms and almost immediate improvement in both venous thrombosis and intracranial hypotension. CSF venous fistulae as a cause of SIH is a recently recognized entity, with ongoing research into its treatment through transvenous embolization. Most documented cases focus on patients with headaches. This case highlights a novel presentation, emphasizing the importance of thorough diagnostic workup in patients with cerebral venous thrombosis. Early detection and treatment of this condition can lead to significant clinical improvement, including the resolution of coma.
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Affiliation(s)
- Timothy G White
- Department of Neurosurgery, Zucker School of Medicine at Hofstra/Northwell, Manhasset, NY, USA
| | - Justin Turpin
- Department of Neurosurgery, Zucker School of Medicine at Hofstra/Northwell, Manhasset, NY, USA
| | - Miriam Shao
- Department of Neurosurgery, Zucker School of Medicine at Hofstra/Northwell, Manhasset, NY, USA
| | - Jared B Bassett
- Department of Neurosurgery, Zucker School of Medicine at Hofstra/Northwell, Manhasset, NY, USA
| | | | - Richard B Libman
- Department of Neurology, North Shore University Hospital/Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Manhasset, NY, USA
| | - Athos Patsalides
- Department of Neurosurgery, Zucker School of Medicine at Hofstra/Northwell, Manhasset, NY, USA
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2
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Farnsworth PJ, Madhavan AA, Verdoorn JT, Shlapak DP, Johnson DR, Cutsforth-Gregory JK, Brinjikji W, Lehman VT. Spontaneous intracranial hypotension: updates from diagnosis to treatment. Neuroradiology 2023; 65:233-243. [PMID: 36336758 DOI: 10.1007/s00234-022-03079-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Accepted: 10/26/2022] [Indexed: 11/09/2022]
Abstract
Spontaneous intracranial hypotension (SIH) is caused by spinal cerebrospinal fluid (CSF) leaks, which result in continued loss of CSF volume and multiple debilitating clinical manifestations. The estimated annual incidence of SIH is 5/100,000. Diagnostic methods have evolved in recent years due to improved understanding of pathophysiology and implementation of advanced myelographic techniques. Here, we synthesize recent updates and contextualize them in an algorithm for diagnosis and treatment of SIH, highlighting basic principles and points of practice variability or continued debate. This discussion includes finer points of SIH diagnosis, CSF leak classification systems, less common types and variants of CSF leaks, brain MRI Bern scoring, potential SIH complications, key technical considerations, and positioning strategies for different types of dynamic myelography. The roles of conservative measures, non-targeted or targeted blood patches, surgery, and recently developed endovascular techniques are presented.
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Affiliation(s)
- Paul J Farnsworth
- Department of Radiology, Mayo Clinic, 200 First St SW, Rochester, MN, 55905, USA.
| | - Ajay A Madhavan
- Department of Radiology, Mayo Clinic, 200 First St SW, Rochester, MN, 55905, USA
| | - Jared T Verdoorn
- Department of Radiology, Mayo Clinic, 200 First St SW, Rochester, MN, 55905, USA
| | - Darya P Shlapak
- Department of Radiology, Mayo Clinic, 200 First St SW, Rochester, MN, 55905, USA
| | - Derek R Johnson
- Department of Radiology, Mayo Clinic, 200 First St SW, Rochester, MN, 55905, USA.,Department of Neurology, Mayo Clinic, Rochester, MN, USA
| | | | - Waleed Brinjikji
- Department of Radiology, Mayo Clinic, 200 First St SW, Rochester, MN, 55905, USA.,Department of Neurosurgery, Mayo Clinic, Rochester, MN, USA
| | - Vance T Lehman
- Department of Radiology, Mayo Clinic, 200 First St SW, Rochester, MN, 55905, USA
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3
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Chen Y, Lin J, Yan W. A Prosperous Application of Hydrogels With Extracellular Vesicles Release for Traumatic Brain Injury. Front Neurol 2022; 13:908468. [PMID: 35720072 PMCID: PMC9201053 DOI: 10.3389/fneur.2022.908468] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Accepted: 05/05/2022] [Indexed: 01/29/2023] Open
Abstract
Traumatic brain injury (TBI) is one of the leading causes of disability worldwide, becoming a heavy burden to the family and society. However, the complexity of the brain and the existence of blood-brain barrier (BBB) do limit most therapeutics effects through simple intravascular injection. Hence, an effective therapy promoting neurological recovery is urgently required. Although limited spontaneous recovery of function post-TBI does occur, increasing evidence indicates that exosomes derived from stem cells promote these endogenous processes. The advantages of hydrogels for transporting drugs and stem cells to target injured sites have been discussed in multitudinous studies. Therefore, the combined employment of hydrogels and exosomes for TBI is worthy of further study. Herein, we review current research associated with the application of hydrogels and exosomes for TBI. We also discuss the possibilities and advantages of exosomes and hydrogels co-therapies after TBI.
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Lewis A, Jain R, Frontera J, Placantonakis DG, Galetta S, Balcer L, Melmed KR. COVID-19 associated brain/spinal cord lesions and leptomeningeal enhancement: A meta-analysis of the relationship to CSF SARS-CoV-2. J Neuroimaging 2021; 31:826-848. [PMID: 34105198 PMCID: PMC8242764 DOI: 10.1111/jon.12880] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Revised: 05/03/2021] [Accepted: 05/07/2021] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND AND PURPOSE We reviewed the literature to evaluate cerebrospinal fluid (CSF) results from patients with coronavirus disease 2019 (COVID-19) who had neurological symptoms and had an MRI that showed (1) central nervous system (CNS) hyperintense lesions not attributed to ischemia and/or (2) leptomeningeal enhancement. We sought to determine if these findings were associated with a positive CSF severe acute respiratory syndrome associated coronavirus 2 (SARS-CoV-2) polymerase chain reaction (PCR). METHODS We performed a systematic review of Medline and Embase from December 1, 2019 to November 18, 2020. CSF results were evaluated based on the presence/absence of (1) ≥ 1 CNS hyperintense lesion and (2) leptomeningeal enhancement. RESULTS In 117 publications, we identified 193 patients with COVID-19 who had an MRI of the CNS and CSF testing. There were 125 (65%) patients with CNS hyperintense lesions. Patients with CNS hyperintense lesions were significantly more likely to have a positive CSF SARS-CoV-2 PCR (10% [9/87] vs. 0% [0/43], p = 0.029). Of 75 patients who had a contrast MRI, there were 20 (27%) patients who had leptomeningeal enhancement. Patients with leptomeningeal enhancement were significantly more likely to have a positive CSF SARS-CoV-2 PCR (25% [4/16] vs. 5% [2/42], p = 0.024). CONCLUSION The presence of CNS hyperintense lesions or leptomeningeal enhancement on neuroimaging from patients with COVID-19 is associated with increased likelihood of a positive CSF SARS-CoV-2 PCR. However, a positive CSF SARS-CoV-2 PCR is uncommon in patients with these neuroimaging findings, suggesting they are often related to other etiologies, such as inflammation, hypoxia, or ischemia.
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Affiliation(s)
- Ariane Lewis
- Department of NeurologyNYU Langone Medical CenterNew YorkNew YorkUSA
- Department of NeurosurgeryNYU Langone Medical CenterNew YorkNew YorkUSA
| | - Rajan Jain
- Department of NeurosurgeryNYU Langone Medical CenterNew YorkNew YorkUSA
- Department of RadiologyNYU Langone Medical CenterNew YorkNew YorkUSA
| | - Jennifer Frontera
- Department of NeurologyNYU Langone Medical CenterNew YorkNew YorkUSA
- Department of NeurosurgeryNYU Langone Medical CenterNew YorkNew YorkUSA
| | | | - Steven Galetta
- Department of NeurologyNYU Langone Medical CenterNew YorkNew YorkUSA
- Department of OphthalmologyNYU Langone Medical CenterNew YorkNew YorkUSA
| | - Laura Balcer
- Department of NeurologyNYU Langone Medical CenterNew YorkNew YorkUSA
- Department of OphthalmologyNYU Langone Medical CenterNew YorkNew YorkUSA
- Department of Population HealthNYU Langone Medical CenterNew YorkNew YorkUSA
| | - Kara R. Melmed
- Department of NeurologyNYU Langone Medical CenterNew YorkNew YorkUSA
- Department of NeurosurgeryNYU Langone Medical CenterNew YorkNew YorkUSA
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5
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Li J, Wan C. Non-invasive detection of intracranial pressure related to the optic nerve. Quant Imaging Med Surg 2021; 11:2823-2836. [PMID: 34079745 DOI: 10.21037/qims-20-1188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Intracranial pressure (ICP) is associated with a variety of diseases. Early diagnosis and the timely intervention of elevated ICP are effective means to clinically reduce the morbidity and mortality of some diseases. The detection and judgment of reduced ICP are beneficial to glaucoma doctor and neuro ophthalmologist to diagnose optic nerve disease earlier. It is important to evaluate and monitor ICP clinically. Although invasive ICP detection is the gold standard, it can have complications. Most non-invasive ICP tests are related to the optic nerve and surrounding tissues due to their anatomical characteristics. Ultrasound, magnetic resonance imaging, transcranial Doppler, papilledema on optical coherence tomography, visual evoked potential, ophthalmodynamometry, the assessment of spontaneous retinal venous pulsations, and eye-tracking have potential for application. Although none of these methods can completely replace invasive technology; however, its repeatable, low risk, high accuracy, gradually attracted people's attention. This review summarizes the non-invasive ICP detection methods related to the optic nerve and the role of the diagnosis and prognosis of neurological disorders and glaucoma. We discuss the advantages and challenges and predict possible areas of development in the future.
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Affiliation(s)
- Jian Li
- Department of Radiology, the First Hospital of China Medical University, Shenyang, China
| | - Chao Wan
- Department of Ophthalmology, the First Hospital of China Medical University, Shenyang, China
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6
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Yu R, Kale H, Branstetter BF, Palfey S, Agarwal V. Epidural Contrast Volume on Post-Myelogram Lumbar CT Predicts the Rate of Subsequent Blood Patch Treatment. J Neuroimaging 2021; 31:691-695. [PMID: 33877730 DOI: 10.1111/jon.12852] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Revised: 02/15/2021] [Accepted: 02/26/2021] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND AND PURPOSE Headaches due to cerebrospinal fluid (CSF) leakage are a well-known complication of dural puncture. The purpose of this study was to determine whether the presence and volume of epidural contrast on postmyelogram CTs of the lumbar spine were associated with post-dural puncture headaches (PDPHs) requiring epidural blood patch (EBP) treatment. METHODS A retrospective case control study of all fluoroscopically guided lumbar myelograms performed over a 5-year period by a single radiology practitioner assistant was performed. Ten patients who underwent EBP treatment after their myelograms were identified. Forty-six patients with similar demographics who did not receive blood patches were then selected. CT-lumbar myelogram images of patients and controls were reviewed. The volume of epidural contrast was then quantified as "severe" or "mild." Severe epidural contrast was defined as contrast detected in the ventral epidural space, the extra-foraminal space, or extending greater than or equal to the length of two vertebral bodies from the level of dural puncture. RESULTS Some amount of epidural contrast was seen in all patients. However, a severe volume of epidural contrast was associated with increased risk for PDPH requiring an EBP (odds ratio = 37.00; 95% CI = 4.1-330.8, p = 0.0012). CONCLUSION Severe epidural contrast on postmyelogram CTs of the lumbar spine was associated with an increased risk of PDPH requiring EBP treatment. When present, this finding can alert the proceduralist that the patient may require closer observation and follow up with earlier intervention.
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Affiliation(s)
- Robinson Yu
- Bay Imaging Consultants Medical Group, Walnut Creek, California, USA
| | - Hrishikesh Kale
- Department of Radiology, Kokilaben Dhirubhai Ambani Hospital and Medical Research Institute, Mumbai, Maharashtra, India
| | - Barton F Branstetter
- Department of Radiology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Stacie Palfey
- Department of Radiology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Vikas Agarwal
- Department of Radiology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
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Delayed recurrence of spontaneous intracranial hypotension syndrome mimicking a Chiari I malformation: Case report with a review of the literature. Neurochirurgie 2020; 67:479-486. [PMID: 33276003 DOI: 10.1016/j.neuchi.2020.11.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Revised: 09/21/2020] [Accepted: 11/21/2020] [Indexed: 11/23/2022]
Abstract
INTRODUCTION Cerebellar tonsils descent seen on brain MRI is, along with other findings, a recognized radiological sign of possible spontaneous intracranial hypotension (SIH). The short-term outcome of SIH is usually favorable with symptoms improvement and reversibility of the low-lying tonsils. Nevertheless, data on the long-term outcome are lacking or inconsistent. CASE REPORT A 32-year-old woman presented to her general practitioner with a six months history of non-specific headaches. An MRI brain with gadolinium showed a 12mm tonsillar descent with no other remarkable findings. Headaches were initially managed conservatively as migraines. Following the onset of progressive upper back and shoulder pain at rest, nausea, photophobia and fogging in her vision, the patient was referred to our Department with a suspicion of symptomatic Chiari I malformation. After an in-depth anamnesis, it emerged a previous history of SIH, 14 years earlier, successfully treated conservatively in another center. A whole spine MRI confirmed the suspicion of recurrent SIH showing an anterior cervico-thoracic epidural fluid collection. The patient underwent an epidural blood patch with complete resolution of the symptoms and radiological signs. DISCUSSION To our knowledge, this case is the first report of delayed recurrence of a SIH successfully treated conservatively over 10 years earlier. The etiopathogenesis and management of this rarity with literature review is discussed. CONCLUSION An isolated cerebellar tonsil descent with no other remarkable findings on brain MRI and a previous history of SIH should always alert the clinician of a possible late recurrence of a CSF leak and avoid unnecessary Chiari I malformation surgical procedures.
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Nagel SJ, Helland L, Woodroffe RW, Frizon LA, Holland MT, Machado AG, Yamaguchi S, Gillies GT, Howard MA, Wilson S. Durotomy Surrogate and Seals for Intradural Spinal Cord Stimulators: Apparatus and Review of Clinical Methods and Materials. Neuromodulation 2019; 22:916-929. [DOI: 10.1111/ner.12913] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2018] [Revised: 10/14/2018] [Accepted: 11/14/2018] [Indexed: 12/20/2022]
Affiliation(s)
- Sean J. Nagel
- Neurological SurgeryCleveland Clinic Cleveland, OH USA
| | - Logan Helland
- Department of NeurosurgeryUniversity of Iowa Hospitals and Clinics Iowa City IA USA
| | - Royce W. Woodroffe
- Department of NeurosurgeryUniversity of Iowa Hospitals and Clinics Iowa City IA USA
| | | | - Marshall T. Holland
- Department of NeurosurgeryUniversity of Iowa Hospitals and Clinics Iowa City IA USA
| | | | - Satoshi Yamaguchi
- Department of NeurosurgeryUniversity of Iowa Hospitals and Clinics Iowa City IA USA
| | - George T. Gillies
- Department of Mechanical and Aerospace EngineeringUniversity of Virginia Charlottesville VA USA
| | - Matthew A. Howard
- Department of NeurosurgeryUniversity of Iowa Hospitals and Clinics Iowa City IA USA
| | - Saul Wilson
- Department of NeurosurgeryUniversity of Iowa Hospitals and Clinics Iowa City IA USA
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9
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Okon MD, Roberts CJ, Mahmoud AM, Springer AN, Small RH, McGregor JM, Katz SE. Characteristics of the cerebrospinal fluid pressure waveform and craniospinal compliance in idiopathic intracranial hypertension subjects. Fluids Barriers CNS 2018; 15:21. [PMID: 30064442 PMCID: PMC6069551 DOI: 10.1186/s12987-018-0106-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2018] [Accepted: 07/14/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Idiopathic intracranial hypertension (IIH) is a condition of abnormally high intracranial pressure with an unknown etiology. The objective of this study is to characterize craniospinal compliance and measure the cerebrospinal fluid (CSF) pressure waveform as CSF is passively drained during a diagnostic and therapeutic lumbar puncture (LP) in IIH. METHODS Eighteen subjects who met the Modified Dandy Criteria, including papilledema and visual field loss, received an ultrasound guided LP where CSF pressure (CSFP) was recorded at each increment of CSF removal. Joinpoint regression models were used to calculate compliance from CSF pressure and the corresponding volume removed at each increment for each subject. Twelve subjects had their CSFP waveform recorded with an electronic transducer. Body mass index, mean CSFP, and cerebral perfusion pressure (CPP) were also calculated. T-tests were used to compare measurements, and correlations were performed between parameters. RESULTS Cerebrospinal fluid pressure, CSFP pulse amplitude (CPA), and CPP were found to be significantly different (p < 0.05) before and after the LP. CSFP and CPA decreased after the LP, while CPP increased. The craniospinal compliance significantly increased (p < 0.05) post-LP. CPA and CSFP were significantly positively correlated. CONCLUSIONS Both low craniospinal compliance (at high CSFP) and high craniospinal compliance (at low CSFP) regions were determined. The CSFP waveform morphology in IIH was characterized and CPA was found to be positively correlated to the magnitude of CSFP. Future studies will investigate how craniospinal compliance may correlate to symptoms and/or response to therapy in IIH subjects.
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Affiliation(s)
- Monica D Okon
- Department of Biomedical Engineering, The Ohio State University, 1080 Carmack Rd, Columbus, OH, 43210, USA
| | - Cynthia J Roberts
- Department of Biomedical Engineering, The Ohio State University, 1080 Carmack Rd, Columbus, OH, 43210, USA. .,Department of Ophthalmology & Visual Science, The Ohio State University, 915 Olentangy River Rd, Columbus, OH, 43212, USA.
| | - Ashraf M Mahmoud
- Department of Biomedical Engineering, The Ohio State University, 1080 Carmack Rd, Columbus, OH, 43210, USA.,Department of Ophthalmology & Visual Science, The Ohio State University, 915 Olentangy River Rd, Columbus, OH, 43212, USA
| | - Andrew N Springer
- Department of Anesthesiology, The Ohio State University, 410W. 10th Avenue, Columbus, OH, 43210, USA
| | - Robert H Small
- Department of Biomedical Engineering, The Ohio State University, 1080 Carmack Rd, Columbus, OH, 43210, USA.,Department of Anesthesiology, The Ohio State University, 410W. 10th Avenue, Columbus, OH, 43210, USA
| | - John M McGregor
- Department of Neurosurgery, The Ohio State University, 1581 Dodd Drive, Columbus, OH, 43210, USA
| | - Steven E Katz
- Ohio Neuro-Ophthalmology, Orbital Disease & Oculoplastics, 3545 Olentangy River Rd, Suite 200, Columbus, OH, 43214, USA
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10
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Vela Marín A, Seral Moral P, Bernal Lafuente C, Izquierdo Hernández B. Diagnostic imaging in neuro-ophthalmology. RADIOLOGIA 2018. [DOI: 10.1016/j.rxeng.2018.03.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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11
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Vela Marín AC, Seral Moral P, Bernal Lafuente C, Izquierdo Hernández B. Diagnostic imaging in neuro-ophthalmology. RADIOLOGIA 2018; 60:190-207. [PMID: 29366504 DOI: 10.1016/j.rx.2017.11.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2017] [Revised: 11/05/2017] [Accepted: 11/14/2017] [Indexed: 11/16/2022]
Abstract
Neuro-ophthalmology is a field combining neurology and ophthalmology that studies diseases that affect the visual system and the mechanisms that control eye movement and pupil function. Imaging tests make it possible to thoroughly assess the relevant anatomy and disease of the structures that make up the visual pathway, the nerves that control eye and pupil movement, and the orbital structures themselves. This article is divided into three sections (review of the anatomy, appropriate imaging techniques, and evaluation of disease according to clinical symptoms), with the aim of providing useful tools that will enable radiologists to choose the best imaging technique for the differential diagnosis of patients' problems to reach the correct diagnosis of their disease.
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Affiliation(s)
- A C Vela Marín
- Servicio de Radiodiagnóstico, Hospital Universitario Miguel Servet, Zaragoza, España.
| | - P Seral Moral
- Servicio de Radiodiagnóstico, Hospital Universitario Miguel Servet, Zaragoza, España
| | - C Bernal Lafuente
- Servicio de Radiodiagnóstico, Hospital Universitario Miguel Servet, Zaragoza, España
| | - B Izquierdo Hernández
- Servicio de Radiodiagnóstico, Hospital Universitario Miguel Servet, Zaragoza, España
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12
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Nelson BB, Goodrich LR, Barrett MF, Grinstaff MW, Kawcak CE. Use of contrast media in computed tomography and magnetic resonance imaging in horses: Techniques, adverse events and opportunities. Equine Vet J 2017; 49:410-424. [DOI: 10.1111/evj.12689] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2016] [Accepted: 04/04/2017] [Indexed: 12/20/2022]
Affiliation(s)
- B. B. Nelson
- Gail Holmes Equine Orthopaedic Research Center, Department of Clinical Sciences; College of Veterinary Medicine and Biomedical Sciences, Colorado State University; Fort Collins Colorado USA
| | - L. R. Goodrich
- Gail Holmes Equine Orthopaedic Research Center, Department of Clinical Sciences; College of Veterinary Medicine and Biomedical Sciences, Colorado State University; Fort Collins Colorado USA
| | - M. F. Barrett
- Gail Holmes Equine Orthopaedic Research Center, Department of Clinical Sciences; College of Veterinary Medicine and Biomedical Sciences, Colorado State University; Fort Collins Colorado USA
- Department of Environmental and Radiological Health Sciences; Colorado State University; Fort Collins Colorado USA
| | - M. W. Grinstaff
- Departments of Biomedical Engineering, Chemistry, Materials Science & Engineering and Medicine; Boston University; Boston Massachusetts USA
| | - C. E. Kawcak
- Gail Holmes Equine Orthopaedic Research Center, Department of Clinical Sciences; College of Veterinary Medicine and Biomedical Sciences, Colorado State University; Fort Collins Colorado USA
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13
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Swanson TM, Isaacson BM, Cyborski CM, French LM, Tsao JW, Pasquina PF. Traumatic Brain Injury Incidence, Clinical Overview, and Policies in the US Military Health System Since 2000. Public Health Rep 2017; 132:251-259. [PMID: 28135424 DOI: 10.1177/0033354916687748] [Citation(s) in RCA: 65] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Exposure to explosive armaments during Operation Iraqi Freedom and Operation Enduring Freedom contributed to approximately 14% of the 352 612 traumatic brain injury (TBI) diagnoses in the US military between 2000 and 2016. The US Department of Defense issued guidelines in 2009 to (1) standardize TBI diagnostic criteria; (2) classify TBI according to mechanism and severity; (3) categorize TBI symptoms as somatic, psychological, or cognitive; and (4) systematize types of care given during the acute and rehabilitation stages of TBI treatment. Polytrauma and associated psychological and neurologic conditions may create barriers to optimal rehabilitation from TBI. Given the completion of recent combat operations and the transition of TBI patients into long-term care within the US Department of Veterans Affairs system, a review of the literature concerning TBI is timely. Long-term follow-up care for patients who have sustained TBI will remain a critical issue for the US military.
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Affiliation(s)
- Thomas M Swanson
- 1 Department of Physical Medicine and Rehabilitation, Center for Rehabilitation Sciences Research, Uniformed Services University of the Health Sciences, Bethesda, MD, USA.,2 The Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, MD, USA.,3 Department of Orthopaedics, Walter Reed National Military Medical Center, Bethesda, MD, USA
| | - Brad M Isaacson
- 1 Department of Physical Medicine and Rehabilitation, Center for Rehabilitation Sciences Research, Uniformed Services University of the Health Sciences, Bethesda, MD, USA.,2 The Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, MD, USA
| | - Cherina M Cyborski
- 1 Department of Physical Medicine and Rehabilitation, Center for Rehabilitation Sciences Research, Uniformed Services University of the Health Sciences, Bethesda, MD, USA.,4 National Intrepid Center of Excellence, Walter Reed National Military Medical Center, Bethesda, MD, USA
| | - Louis M French
- 1 Department of Physical Medicine and Rehabilitation, Center for Rehabilitation Sciences Research, Uniformed Services University of the Health Sciences, Bethesda, MD, USA.,4 National Intrepid Center of Excellence, Walter Reed National Military Medical Center, Bethesda, MD, USA.,5 Center for Neuroscience and Regenerative Medicine, Bethesda, MD, USA
| | - Jack W Tsao
- 1 Department of Physical Medicine and Rehabilitation, Center for Rehabilitation Sciences Research, Uniformed Services University of the Health Sciences, Bethesda, MD, USA.,6 Bureau of Medicine and Surgery, Wounded, Ill and Injured, US Navy, Falls Church, VA, USA
| | - Paul F Pasquina
- 1 Department of Physical Medicine and Rehabilitation, Center for Rehabilitation Sciences Research, Uniformed Services University of the Health Sciences, Bethesda, MD, USA.,7 Department of Rehabilitation, Walter Reed National Military Medical Center, Bethesda, MD, USA
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Abstract
Traumatic brain injury (TBI) is a major cause of morbidity and mortality worldwide. Imaging plays an important role in the evaluation, diagnosis, and triage of patients with TBI. Recent studies suggest that it also helps predict patient outcomes. TBI consists of multiple pathoanatomic entities. This article reviews the current state of TBI imaging including its indications, benefits and limitations of the modalities, imaging protocols, and imaging findings for each of these pathoanatomic entities. Also briefly surveyed are advanced imaging techniques, which include several promising areas of TBI research.
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Affiliation(s)
- Christopher A Mutch
- Department of Radiology, University of California, San Francisco, 505 Parnassus Avenue, M391, San Francisco, CA 94143, USA
| | - Jason F Talbott
- Department of Radiology, San Francisco General Hospital, University of California, San Francisco, 1001 Potrero Avenue, San Francisco, CA 94110, USA.
| | - Alisa Gean
- Department of Radiology, San Francisco General Hospital, University of California, San Francisco, 1001 Potrero Avenue, San Francisco, CA 94110, USA
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15
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Yıldırım MS, Kara S, Albayram MS, Okkesim Ş. Evaluation of Spontaneous Spinal Cerebrospinal Fluid Leaks Disease by Computerized Image Processing. Methods Inf Med 2016; 55:215-22. [PMID: 27096307 DOI: 10.3414/me15-01-0148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2015] [Accepted: 03/21/2016] [Indexed: 11/09/2022]
Abstract
BACKGROUND Spontaneous Spinal Cerebrospinal Fluid Leaks (SSCFL) is a disease based on tears on the dura mater. Due to widespread symptoms and low frequency of the disease, diagnosis is problematic. Diagnostic lumbar puncture is commonly used for diagnosing SSCFL, though it is invasive and may cause pain, inflammation or new leakages. T2-weighted MR imaging is also used for diagnosis; however, the literature on T2-weighted MRI states that findings for diagnosis of SSCFL could be erroneous when differentiating the diseased and control. One another technique for diagnosis is CT-myelography, but this has been suggested to be less successful than T2-weighted MRI and it needs an initial lumbar puncture. OBJECTIVES This study aimed to develop an objective, computerized numerical analysis method using noninvasive routine Magnetic Resonance Images that can be used in the evaluation and diagnosis of SSCFL disease. METHODS Brain boundaries were automatically detected using methods of mathematical morphology, and a distance transform was employed. According to normalized distances, average densities of certain sites were proportioned and a numerical criterion related to cerebrospinal fluid distribution was calculated. RESULTS The developed method was able to differentiate between 14 patients and 14 control subjects significantly with p = 0.0088 and d = 0.958. Also, the pre and post-treatment MRI of four patients was obtained and analyzed. The results were differentiated statistically (p = 0.0320, d = 0.853). CONCLUSIONS An original, noninvasive and objective diagnostic test based on computerized image processing has been developed for evaluation of SSCFL. To our knowledge, this is the first computerized image processing method for evaluation of the disease. Discrimination between patients and controls shows the validity of the method. Also, post-treatment changes observed in four patients support this verdict.
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Affiliation(s)
- Mustafa S Yıldırım
- Mustafa S. Yıldırım, Institute of Biomedical Engineering, Fatih University, Istanbul, Turkey, E-mail:
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Imaging Interpretation of Temporal Bone Studies in a Patient with Tinnitus: A Systematic Approach. Neuroimaging Clin N Am 2016; 26:207-25. [PMID: 27154604 DOI: 10.1016/j.nic.2015.12.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Tinnitus is an auditory perception of internal origin. Tinnitus is not a diagnosis but a symptom with many possible causes and correspondingly divergent pathophysiologic, anatomic, diagnostic, and therapeutic considerations. This article provides a summary of the imaging findings of structural causes of tinnitus.
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Tian W, Zhang J, Chen J, Liu Y, Chen X, Wang N. A quantitative study of intracranial hypotensive syndrome by magnetic resonance. Clin Neurol Neurosurg 2015; 141:71-6. [PMID: 26745515 DOI: 10.1016/j.clineuro.2015.12.014] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2015] [Revised: 12/03/2015] [Accepted: 12/13/2015] [Indexed: 11/25/2022]
Abstract
OBJECTIVES The study aims to investigate the magnetic resonance imaging (MRI) findings of intracranial hypotension syndrome (IHS) and the change of quantitative indicators, so as to yield a deeper understanding of the disease. PATIENTS AND METHODS The clinical data and MRI findings of 26 cases of IHS which were confirmed by lumbar puncture were retrospectively analyzed. Two physicians evaluated the MRI findings including thickening and enhancement of dural, pituitary enlargement, subdural effusion (hematocele), venous engorgement and brain sagging, and measured the quantitative indicators including mamillopontine distance and pontomesencephalic angle. The consistency between the two results of the physicians was assessed by Kappa consistency test. The differences of mamillopontine distance and pontomesencephalic angle between the patient group and the control group were determined by paired t-test. The diagnostic efficiency of mamillopontine distance and pontomesencephalic angle was assessed by area under the ROC curve, and their best diagnostic thresholds were also determined, respectively. Age- and sex-matched healthy volunteers controls (n=26) were recruited and served as the control group. RESULTS All of the 26 patients suffered from the characterized by orthostatic headache of IHS. The clinical evaluations of dural thickening and enhancement, pituitary enlargement, subdural effusion (hematocele), venous engorgement by the two physicians showed excellent agreements (κ=0.808, 1 and 0.906, P<0.01), and the clinical evaluations of brain sagging showed medium agreements (κ=0.606, P<0.01). The mamillopontine distance and pontomesencephalic angle of the patient group were 5.4 ± 1.6mm and 47.8 ± 8.7°, respectively, which were obviously less than those of the control group (6.9 ± 1.1mm and 61.0 ± 6.1°, respectively), and the differences were statistically significant (t=-4.563, P<0.01; t=-.329, P<0.01). The area under ROC curve of mamillopontine distance and pontomesencephalic angle were 0.774 and 0.908, respectively, and the diagnostic value of pontomesencephalic angle was higher than that of the mamillopontine distance. The sensitivity and specificity were 73.1% and 73.1%, respectively, when diagnostic threshold of mamillopontine distance was 6.4mm. The sensitivity and specificity were 76.9% and 96.2%, when diagnostic threshold of pontomesencephalic angle was 51.7°. CONCLUSION The MRI findings presented characteristic features of IHS. The quantitative indicators including mamillopontine distance and pontomesencephalic angle were helpful for clinical diagnosis of subjective findings of IHS.
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Affiliation(s)
- Weizhong Tian
- Department of Radiology, Taizhou People's Hospital, Taizhou 225300, Jiangsu Province, China
| | - Ji Zhang
- Department of Radiology, Taizhou People's Hospital, Taizhou 225300, Jiangsu Province, China.
| | - Jinhua Chen
- Department of Radiology, Taizhou People's Hospital, Taizhou 225300, Jiangsu Province, China
| | - Ying Liu
- Department of Neurology, Taizhou People's Hospital, Taizhou 225300, Jiangsu Province, China
| | - Xiaoyun Chen
- Department of Radiology, Taizhou People's Hospital, Taizhou 225300, Jiangsu Province, China
| | - Ning Wang
- Department of Radiology, Taizhou People's Hospital, Taizhou 225300, Jiangsu Province, China
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Mullen KR, Furness MC, Johnson AL, Norman TE, Hart KA, Burton AJ, Bicahlo RC, Ainsworth DM, Thompson MS, Scrivani PV. Adverse reactions in horses that underwent general anesthesia and cervical myelography. J Vet Intern Med 2015; 29:954-60. [PMID: 25857513 PMCID: PMC4895421 DOI: 10.1111/jvim.12590] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2014] [Revised: 03/09/2015] [Accepted: 03/10/2015] [Indexed: 11/29/2022] Open
Abstract
Background The study was prompted by a perceived high prevalence of myelographic complications varying in severity and type, and attributed to the contrast material or the procedure. Hypotheses 1. Any adverse reaction (AAR) is associated with a change in CSF volume induced either by removal of CSF or addition of contrast material. 2. AAR occurs more frequently in horses with higher premyelography neurologic grade. 3. Nonspecific hyperthermia is attenuated by anti‐inflammatory and osmotic agents. Animals Horses (n = 278) that underwent myelography between 2000 and 2012 at 5 institutions: A (87), B (68), C (65), D (46), and E (12). Methods Multi‐institutional, retrospective, observational cross‐sectional study. Results AAR were observed in 95/278 (34%) horses, were associated with longer general anesthesia time (P = .04) and higher contrast‐medium volume (P = .04); euthanasia because of AAR was performed in 5/278 (2%) horses. Adverse neurologic reactions were the most common type of complication observed occurring in 15/278 (5%) and 42/235 (18%) of horses in the intra‐ and postmyelography periods. A relationship between AAR and premyelography neurologic grade was not identified (P = .31). Nonspecific hyperthermia was observed in 25/235 (11%) horses; no relationship was observed with administration of anti‐inflammatory drugs and osmotic agents (P = .30). Conclusions and clinical importance The category of AAR occurred in one‐third of the horses generally was mild and self‐limiting. These reactions were associated with increased contrast‐medium volume and longer anesthesia time; but, no specific procedural recommendations could be made because of small odds ratios (OR) of <2 for each 1 mL increase in contrast material and for each 1 minute of additional anesthesia time.
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Affiliation(s)
- K R Mullen
- Cornell University College of Veterinary Medicine, Ithaca, NY
| | - M C Furness
- Ontario Veterinary College, Guelph University, Guelph, ON
| | - A L Johnson
- University of Pennsylvania School of Veterinary Medicine, Kennett Square, PA
| | - T E Norman
- Texas A&M College of Veterinary Medicine, College Station, TX
| | - K A Hart
- University of Georgia College of Veterinary Medicine, Athens, GA
| | - A J Burton
- University of Georgia College of Veterinary Medicine, Athens, GA
| | - R C Bicahlo
- Cornell University College of Veterinary Medicine, Ithaca, NY
| | - D M Ainsworth
- Cornell University College of Veterinary Medicine, Ithaca, NY
| | - M S Thompson
- Cornell University College of Veterinary Medicine, Ithaca, NY
| | - P V Scrivani
- Cornell University College of Veterinary Medicine, Ithaca, NY
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Frevert U, Nacer A. Fatal cerebral malaria: a venous efflux problem. Front Cell Infect Microbiol 2014; 4:155. [PMID: 25414834 PMCID: PMC4222339 DOI: 10.3389/fcimb.2014.00155] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2014] [Accepted: 10/13/2014] [Indexed: 12/20/2022] Open
Abstract
Most Plasmodium falciparum-infected children with cerebral malaria (CM) die from respiratory arrest, but the underlying pathology is unclear. Here we present a model in which the ultimate cause of death from CM is severe intracranial hypertension. Dynamic imaging of mice infected with P. berghei ANKA, an accepted model for experimental CM, revealed that leukocyte adhesion impairs the venous blood flow by reducing the functional lumen of postcapillary venules (PCV). The resulting increase in intracranial pressure (ICP) exacerbates cerebral edema formation, a hallmark of both murine and pediatric CM. We propose that two entirely different pathogenetic mechanisms-cytoadherence of P. falciparum-infected erythrocytes in pediatric CM and leukocyte arrest in murine CM-result in the same pathological outcome: a severe increase in ICP leading to brainstem herniation and death from respiratory arrest. The intracranial hypertension (IH) model unifies previous hypotheses, applies to human and experimental CM alike, eliminates the need to explain any selective recognition mechanism Plasmodium might use to target multiple sensitive sites in the brain, and explains how an intravascular parasite can cause so much neuronal dysfunction.
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Affiliation(s)
- Ute Frevert
- Division of Medical Parasitology, Department of Microbiology, New York University School of Medicine New York, NY, USA
| | - Adéla Nacer
- Unité de Biologie des Interactions Hôte-Parasite, Département de Parasitologie et Mycologie, Institut Pasteur Paris, France
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Cauley KA, Fulwadhva U, Dundmadappa SK. Apparent diffusion coefficient measurements to support a diagnosis of intracranial hypotension. Br J Radiol 2014; 87:20140131. [PMID: 24896198 DOI: 10.1259/bjr.20140131] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE Intracranial hypotension (ICH) can be a challenging diagnosis, as cerebrospinal fluid leaks may be difficult to confirm, patients may have other causes for clinical symptoms and imaging findings can be non-specific, particularly in the setting of comorbidities. We investigate the use of brain diffusion measurements [apparent diffusion coefficient (ADC) values] in the assessment of ICH. METHODS 13 cases of ICH were identified retrospectively based on imaging findings and their clinical histories were compared with 13 control subjects. Regional ADC values and average diffusion constant (Dav) from brain slice ADC histograms were measured. RESULTS ADC values trended higher in all brain regions in patients with ICH than those in control subjects, with statistically significant differences in frontal white matter, mid-brain and deep grey structures. Dav determined by a single-slice ADC histogram was significantly higher in patients with ICH than in the control group (p = 0.008). In two cases followed longitudinally, Dav correlated with the patient's symptoms and decreased towards normal value with blood patch. In one case, decreased Dav correlated with the formation of subdural collections. CONCLUSION Cerebral oedema as assessed by increased ADC is strongly correlated with ICH (10 of 13 cases). Histographic analysis of ADC values may offer increased accuracy of ADC measurement. ADC value assessment in the determination of ICH may be particularly useful in complex clinical cases, where treatment is followed over time or where gadolinium is not used and meningeal enhancement cannot be assessed. ADVANCES IN KNOWLEDGE This article investigates the use of brain diffusion measurements in the assessment of ICH in the clinical setting.
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Affiliation(s)
- K A Cauley
- 1 Department of Radiology, Division of Neuroradiology, Columbia University Medical Center, New York, NY, USA
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Guimaraes MD, Bitencourt AGV, Marchiori E, Chojniak R, Gross JL, Kundra V. Imaging acute complications in cancer patients: what should be evaluated in the emergency setting? Cancer Imaging 2014; 14:18. [PMID: 25609051 PMCID: PMC4331823 DOI: 10.1186/1470-7330-14-18] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2014] [Accepted: 02/13/2014] [Indexed: 12/13/2022] Open
Abstract
Increased incidence world-wide of cancer and increased survival has also resulted in physicians seeing more complications in patients with cancer. In many cases, complications are the first manifestations of the disease. They may be insidious and develop over a period of months, or acute and manifest within minutes to days. Imaging examinations play an essential role in evaluating cancer and its complications. Plain radiography and ultrasonography (US) are generally performed initially in an urgent situation due to their wide availability, low cost, and minimal or no radiation exposure. However, depending on a patient's symptoms, evaluation with cross-sectional imaging methods such as computed tomography (CT) and magnetic resonance imaging (MRI) is often necessary. In this review article, we discuss some of the most important acute noninfectious oncological complications for which imaging methods play an essential role in diagnosis.
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Ajlan AM, Al-Jehani H, Torres C, Marcoux J. Deep venous structures distortion in spontaneous intracranial hypotension as an explanation for altered level of consciousness. J Neurointerv Surg 2013; 6:e38. [PMID: 24092865 DOI: 10.1136/neurintsurg-2013-010823.rep] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Spontaneous intracranial hypotension (SIH) is a syndrome of low pressure headache associated with low CSF pressure. The condition is generally considered benign but extreme cases of SIH can lead to changes in the level of consciousness. We describe a case in which alteration in the level of consciousness was prolonged and severe, and could not be explained solely by the presence of subdural collections. MRI of the brain showed evidence of impaired venous flow secondary to brain sagging causing distortion of deep venous structures.
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Affiliation(s)
- Abdulrazag M Ajlan
- Department of Neurosurgery, Stanford, Palo Alto, California, USA Department of Neurosurgery, King Saud University, Saudi Arabia
| | | | - Carlos Torres
- Department of Diagnostic Imaging, University of Ottawa, Ottawa, Ontario, Canada
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Damkier HH, Brown PD, Praetorius J. Cerebrospinal Fluid Secretion by the Choroid Plexus. Physiol Rev 2013; 93:1847-92. [DOI: 10.1152/physrev.00004.2013] [Citation(s) in RCA: 291] [Impact Index Per Article: 26.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
The choroid plexus epithelium is a cuboidal cell monolayer, which produces the majority of the cerebrospinal fluid. The concerted action of a variety of integral membrane proteins mediates the transepithelial movement of solutes and water across the epithelium. Secretion by the choroid plexus is characterized by an extremely high rate and by the unusual cellular polarization of well-known epithelial transport proteins. This review focuses on the specific ion and water transport by the choroid plexus cells, and then attempts to integrate the action of specific transport proteins to formulate a model of cerebrospinal fluid secretion. Significant emphasis is placed on the concept of isotonic fluid transport across epithelia, as there is still surprisingly little consensus on the basic biophysics of this phenomenon. The role of the choroid plexus in the regulation of fluid and electrolyte balance in the central nervous system is discussed, and choroid plexus dysfunctions are described in a very diverse set of clinical conditions such as aging, Alzheimer's disease, brain edema, neoplasms, and hydrocephalus. Although the choroid plexus may only have an indirect influence on the pathogenesis of these conditions, the ability to modify epithelial function may be an important component of future therapies.
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Affiliation(s)
- Helle H. Damkier
- Department of Biomedicine, Health, Aarhus University, Aarhus, Denmark; and Faculty of Life Sciences, Michael Smith Building, Manchester University, Manchester, United Kingdom
| | - Peter D. Brown
- Department of Biomedicine, Health, Aarhus University, Aarhus, Denmark; and Faculty of Life Sciences, Michael Smith Building, Manchester University, Manchester, United Kingdom
| | - Jeppe Praetorius
- Department of Biomedicine, Health, Aarhus University, Aarhus, Denmark; and Faculty of Life Sciences, Michael Smith Building, Manchester University, Manchester, United Kingdom
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Ajlan AM, Al-Jehani H, Torres C, Marcoux J. Deep venous structures distortion in spontaneous intracranial hypotension as an explanation for altered level of consciousness. BMJ Case Rep 2013; 2013:bcr-2013-010823. [PMID: 24068443 DOI: 10.1136/bcr-2013-010823] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Spontaneous intracranial hypotension (SIH) is a syndrome of low pressure headache associated with low CSF pressure. The condition is generally considered benign but extreme cases of SIH can lead to changes in the level of consciousness. We describe a case in which alteration in the level of consciousness was prolonged and severe, and could not be explained solely by the presence of subdural collections. MRI of the brain showed evidence of impaired venous flow secondary to brain sagging causing distortion of deep venous structures.
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Intracranial Hypotension: Improved MRI Detection With Diagnostic Intracranial Angles. AJR Am J Roentgenol 2013; 200:400-7. [DOI: 10.2214/ajr.12.8611] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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McLean LA, Frasier LD, Hedlund GL. Does intracranial venous thrombosis cause subdural hemorrhage in the pediatric population? AJNR Am J Neuroradiol 2012; 33:1281-4. [PMID: 22345498 DOI: 10.3174/ajnr.a2967] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Unexplained SDH in infants and children is an accepted marker for AHT. It has been proposed that IVT may be the initiating event leading to the development of acute SDH, mimicking the appearance of traumatic SDH. Our study aims to investigate if nontraumatic IVT causes SDH in the pediatric population. We retrospectively identified 36 patients with IVT and reviewed neuroimaging studies for the concurrent presence of SDH. In our 36 patients with IVT, no associated SDH was observed. Even with extensive IVT, no SDH was present. Three false-positive diagnoses of IVT were identified in the setting of mastoiditis and traumatic SDH, demonstrating pitfalls in imaging. In conclusion, our findings do not support the previous AHT literature stating that IVT is associated with, or leads to, SDH in neonates, infants, or children.
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Affiliation(s)
- L A McLean
- Department of Radiology, University of Utah, Salt Lake City, Utah 84132-2140, USA.
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Aurand ER, Lampe KJ, Bjugstad KB. Defining and designing polymers and hydrogels for neural tissue engineering. Neurosci Res 2011; 72:199-213. [PMID: 22192467 DOI: 10.1016/j.neures.2011.12.005] [Citation(s) in RCA: 127] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2011] [Revised: 11/07/2011] [Accepted: 12/07/2011] [Indexed: 12/16/2022]
Abstract
The use of biomaterials, such as hydrogels, as neural cell delivery devices is becoming more common in areas of research such as stroke, traumatic brain injury, and spinal cord injury. When reviewing the available research there is some ambiguity in the type of materials used and results are often at odds. This review aims to provide the neuroscience community who may not be familiar with fundamental concepts of hydrogel construction, with basic information that would pertain to neural tissue applications, and to describe the use of hydrogels as cell and drug delivery devices. We will illustrate some of the many tunable properties of hydrogels and the importance of these properties in obtaining reliable and consistent results. It is our hope that this review promotes creative ideas for ways that hydrogels could be adapted and employed for the treatment of a broad range of neurological disorders.
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Affiliation(s)
- Emily R Aurand
- Neuroscience Program, University of Colorado Denver - Anschutz Medical Campus, Aurora, CO 80045, USA.
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