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Levites Y, Dammer EB, Ran Y, Tsering W, Duong D, Abreha M, Gadhavi J, Lolo K, Trejo-Lopez J, Phillips JL, Iturbe A, Erqiuzi A, Moore BD, Ryu D, Natu A, Dillon KD, Torrellas J, Moran C, Ladd TB, Afroz KF, Islam T, Jagirdar J, Funk CC, Robinson M, Borchelt DR, Ertekin-Taner N, Kelly JW, Heppner FL, Johnson EC, McFarland K, Levey AL, Prokop S, Seyfried NT, Golde TE. Aβ Amyloid Scaffolds the Accumulation of Matrisome and Additional Proteins in Alzheimer's Disease. bioRxiv 2023:2023.11.29.568318. [PMID: 38076912 PMCID: PMC10705437 DOI: 10.1101/2023.11.29.568318] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/14/2024]
Abstract
We report a highly significant correlation in brain proteome changes between Alzheimers disease (AD) and CRND8 APP695NL/F transgenic mice. However, integrating protein changes observed in the CRND8 mice with co-expression networks derived from human AD, reveals both conserved and divergent module changes. For the most highly conserved module (M42, matrisome) we find many proteins accumulate in plaques, cerebrovascular amyloid (CAA), dystrophic processes, or a combination thereof. Overexpression of two M42 proteins, midkine (Mdk) and pleiotrophin (PTN), in CRND8 mice brains leads to increased accumulation of A β ; in plaques and in CAA; further, recombinant MDK and PTN enhance A β ; aggregation into amyloid. Multiple M42 proteins, annotated as heparan sulfate binding proteins, bind to fibrillar A β 42 and a non-human amyloid fibril in vitro. Supporting this binding data, MDK and PTN co-accumulate with transthyretin (TTR) amyloid in the heart and islet amyloid polypeptide (IAPP) amyloid in the pancreas. Our findings establish several critical insights. Proteomic changes in modules observed in human AD brains define an A β ; amyloid responsome that is well conserved from mouse model to human. Further, distinct amyloid structures may serve as scaffolds, facilitating the co-accumulation of proteins with signaling functions. We hypothesize that this co-accumulation may contribute to downstream pathological sequalae. Overall, this contextualized understanding of proteomic changes and their interplay with amyloid deposition provides valuable insights into the complexity of AD pathogenesis and potential biomarkers and therapeutic targets.
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Singer W, Schmeichel AM, Sletten DM, Gehrking TL, Gehrking JA, Trejo-Lopez J, Suarez MD, Anderson JK, Bass PH, Lesnick TG, Low PA. Neurofilament light chain in spinal fluid and plasma in multiple system atrophy: a prospective, longitudinal biomarker study. Clin Auton Res 2023; 33:635-645. [PMID: 37603107 PMCID: PMC10840936 DOI: 10.1007/s10286-023-00974-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Accepted: 08/10/2023] [Indexed: 08/22/2023]
Abstract
PURPOSE There is a critical need for reliable diagnostic biomarkers as well as surrogate markers of disease progression in multiple system atrophy (MSA). Neurofilament light chain (NfL) has been reported to potentially meet those needs. We therefore sought to explore the value of NfL in plasma (NfL-p) in contrast to cerebrospinal fluid (NfL-c) as a diagnostic marker of MSA, and to assess NfL-p and NfL-c as markers of clinical disease progression. METHODS Well-characterized patients with early MSA (n = 32), Parkinson's disease (PD; n = 21), and matched controls (CON; n = 15) were enrolled in a prospective, longitudinal study of synucleinopathies with serial annual evaluations. NfL was measured using a high-sensitivity immunoassay, and findings were assessed by disease category and relationship with clinical measures of disease progression. RESULTS Measurements of NfL-c were highly reproducible across immunoassay platforms (Pearson, r = 0.99), while correlation between NfL-c and -p was only moderate (r = 0.66). NfL was significantly higher in MSA compared with CON and PD; the separation was essentially perfect for NfL-c, but there was overlap, particularly with PD, for NfL-p. While clinical measures of disease severity progressively increased over time, NfL-c and -p remained at stable elevated levels within subjects across serial measurements. Neither change in NfL nor baseline NfL were significantly associated with changes in clinical markers of disease severity. CONCLUSIONS These findings confirm NfL-c as a faithful diagnostic marker of MSA, while NfL-p showed less robust diagnostic value. The significant NfL elevation in MSA was found to be remarkably stable over time and was not predictive of clinical disease progression.
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Affiliation(s)
- Wolfgang Singer
- Department of Neurology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA.
| | - Ann M Schmeichel
- Department of Neurology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - David M Sletten
- Department of Neurology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Tonette L Gehrking
- Department of Neurology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Jade A Gehrking
- Department of Neurology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Jorge Trejo-Lopez
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | - Mariana D Suarez
- Department of Neurology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Jennifer K Anderson
- Department of Neurology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Pamela H Bass
- Department of Neurology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Timothy G Lesnick
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN, USA
| | - Phillip A Low
- Department of Neurology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
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3
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Singer W, Schmeichel AM, Sletten DM, Gehrking TL, Gehrking JA, Trejo-Lopez J, Suarez MD, Anderson JK, Bass PH, Lesnick TG, Low PA. Neurofilament Light Chain in Spinal Fluid and Plasma in Multiple System Atrophy - A Prospective, Longitudinal Biomarker Study. Res Sq 2023:rs.3.rs-3201386. [PMID: 37577499 PMCID: PMC10418538 DOI: 10.21203/rs.3.rs-3201386/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/15/2023]
Abstract
Purpose There is a critical need for reliable diagnostic biomarkers as well as surrogate markers of disease progression in multiple system atrophy (MSA). Neurofilament light chain (NfL) has been reported to potentially meet those needs. We therefore sought to explore the value of NfL in plasma (NfL-p) in contrast to CSF (NfL-c) as diagnostic marker of MSA, and to assess NfL-p and NfL-c as markers of clinical disease progression. Methods Well-characterized patients with early MSA (n=32), Parkinson's disease (PD, n=21), and matched controls (CON, n=15) were enrolled in a prospective, longitudinal study of synucleinopathies with serial annual evaluations. NfL was measured using a high sensitivity immunoassay, and findings were assessed by disease category and relationship with clinical measures of disease progression. Results Measurements of NfL-c were highly reproducible across immunoassay platforms (Pearson,r=0.99), while correlation between NfL-c and -p was only moderate (r=0.66). NfL was significantly higher in MSA compared to CON and PD; the separation was essentially perfect for NfL-c, but there was overlap, particularly with PD, for NfL-p. While clinical measures of disease severity progressively increased over time, NfL-c and -p remained at stable elevated levels within subjects across serial measurements. Neither change in NfL nor baseline NfL were significantly associated with changes in clinical markers of disease severity. Conclusions These findings confirm NfL-c as faithful diagnostic marker of MSA, while NfL-p showed less robust diagnostic value. The significant NfL elevation in MSA was found to be remarkably stable over time and was not predictive of clinical disease progression.
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Affiliation(s)
| | | | | | | | | | - Jorge Trejo-Lopez
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | | | | | - Pamela H. Bass
- Department of Neurology, Mayo Clinic, Rochester, MN, USA
| | - Timothy G. Lesnick
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN, USA
| | - Phillip A. Low
- Department of Neurology, Mayo Clinic, Rochester, MN, USA
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Trejo-Lopez J, Kollmeyer T, Praska C, Raghunathan A, Giannini C, Vaubel R, Nguyen A, Jentoft M, Donev K, Zheng G, DiGuardo M, Kipp B, Jenkins R, Ida C. PATH-12. DIFFUSE HEMISPHERIC GLIOMA, H3 G34-MUTANT: A COMPREHENSIVE SEQUENCING AND HIGH-RESOLUTION GENOME-WIDE COPY NUMBER ANALYSIS. Neuro Oncol 2022. [PMCID: PMC9661170 DOI: 10.1093/neuonc/noac209.585] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Abstract
Diffuse hemispheric glioma, H3 G34-mutant (DHG_H3G34) is a novel tumor type in the 2021 WHO CNS classification. We describe a comprehensive sequencing and high-resolution genome-wide copy number analysis of a series of cases clinically tested by a single laboratory (2018-2022). Cases included tumors from 47 unique patients (1 reportedly recurrent) that had an H3-3A G34 mutation detected using an 187-gene mutation and fusion targeted neuro-oncology NGS panel (n=47). A subset (n=18) of cases was also tested Oncoscan chromosomal microarray. Median age at testing was 20 years (range, 12-50). H3-3A G34 mutations included G34R (n=44; 94%), G34V (n=2) and a novel G34E variant considered to be likely clinically relevant (n=1). All DHG_H3G34 were hemispheric tumors, and one tumor was multifocal with midline involvement. Concurrent mutations recurrently involved ATRX (n=38), TERT promoter (n=3; mutually exclusive with ATRX mutations), TP53 (n=43), PDGFRA (n=26), PTEN (n=5), NF1 (n=4, all patients over 20 years), PIK3CA (n=4) and CDKN2A (n=3). The single recurrent tumor also had an MSH6 mutation, and in addition to 3 other cases, had increased number of sequence variants suggestive of a high tumor mutational burden. A single case also showed an FGFR3::FAM184B (exon 17::exon 2) fusion. All cases with available chromosomal microarray data had unbalanced genomes with multiple chromosomal gains/losses, and regions of copy-neutral loss of heterozygosity. The most frequent recurrent (at least 50% of cases) abnormalities were losses involving 3q, 4q, 10q, 13q and 18q, and 17p copy-neutral loss of heterozygosity encompassing TP53 (all but one case had concomitant TP53 mutation), a pattern reminiscent of IDH-mutant astrocytomas. Oncogene amplifications (PDGFRA and PIK3CA) were detected in 3 (of 18) cases. CDKN2A/B deletion was observed in 8 cases (2 homozygous). In conclusion, we describe additional sequence and copy-number abnormalities in DHG_H3G34, expanding the spectrum of genetic changes associated with this novel tumor type.
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Affiliation(s)
| | | | | | | | - Caterina Giannini
- Department of Pathology and Laboratory Medicine, Mayo Clinic , Rochester, MN , USA
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5
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Neth BJ, Cohen Cohen S, Trejo-Lopez J, Brinjikji W, Braksick SA, Fugate JE, Rabinstein AA, Wijdicks EFM. Mycotic aneurysm. Pract Neurol 2022; 22:407-409. [PMID: 35470248 DOI: 10.1136/practneurol-2021-003260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/04/2022] [Indexed: 11/03/2022]
Abstract
Angioinvasive fungal infections of the cerebral vasculature often lead to significant morbidity and mortality. High clinical suspicion and early antifungal therapy could improve outcomes. We describe the fatal case of a patient with a rapidly enlarging cavernous carotid aneurysm due to angioinvasive fungus. This case highlights the challenges in diagnosis and management of this condition.
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Affiliation(s)
- Bryan J Neth
- Mayo Clinic Rochester, Rochester, Minnesota, USA
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Benson JC, Trejo-Lopez J, Bach SE, Schwartz J, Kaufmann TJ, Eckel L, Guerin J. Hypothalamic Pilomyxoid Astrocytoma in a Child with Lipodystrophy. AJNR Am J Neuroradiol 2021; 42:1370-1374. [PMID: 33958332 PMCID: PMC8367624 DOI: 10.3174/ajnr.a7136] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Accepted: 02/16/2021] [Indexed: 11/07/2022]
Abstract
Pilomyxoid astrocytoma is a rare form of pediatric CNS malignancy first classified in 2007 by the World Health Organization. The tumors are similar to pilocytic astrocytomas, sharing both some imaging and histologic traits. However, pilomyxoid astrocytomas portend a more ominous prognosis, with more aggressive local tendencies and a greater proclivity for leptomeningeal spread. Although tissue sampling is ultimately required to differentiate pilocytic astrocytomas and pilomyxoid astrocytomas, some imaging features can be used to suggest a pilomyxoid astrocytoma, including homogeneous enhancement, leptomeningeal seeding, and lack of intratumoral cysts. In this article, a case of a hypothalamic pilomyxoid astrocytoma is described, in which the presenting disorder was profound generalized lipodystrophy. The aforementioned imaging characteristics of pilomyxoid astrocytomas are reviewed, as are the pathologic features of such tumors, including their angiocentric cellular arrangement and myxoid background.
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Affiliation(s)
- J C Benson
- Department of Radiology (J.C.B., T.J.K., L.E., J.G.), Mayo Clinic, Rochester, Minnesota
| | - J Trejo-Lopez
- Department of Laboratory Medicine and Pathology (J.T.-L.), Mayo Clinic, Rochester, Minnesota
| | - S E Bach
- Department of Laboratory Medicine and Pathology (S.E.B.), OSF Healthcare, Peoria, Illinois
| | - J Schwartz
- Departments of Pediatric and Adolescent Medicine (J.S.), Mayo Clinic, Rochester, Minnesota
| | - T J Kaufmann
- Department of Radiology (J.C.B., T.J.K., L.E., J.G.), Mayo Clinic, Rochester, Minnesota
| | - L Eckel
- Department of Radiology (J.C.B., T.J.K., L.E., J.G.), Mayo Clinic, Rochester, Minnesota
| | - J Guerin
- Department of Radiology (J.C.B., T.J.K., L.E., J.G.), Mayo Clinic, Rochester, Minnesota
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Benson JC, Trejo-Lopez J, Boland-Froemming J, Pollock B, Hunt CH, Wald JT. Calcified Pseudoneoplasm of the Neuraxis. AJNR Am J Neuroradiol 2021; 42:1751-1754. [PMID: 34301639 DOI: 10.3174/ajnr.a7237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Accepted: 05/04/2021] [Indexed: 11/07/2022]
Abstract
Calcified pseudoneoplasms of the neuraxis are extremely rare non-neoplastic lesions that can exist anywhere in the CNS. Although benign, the lesions can cause substantial neurologic symptoms, typically related to mass effect on adjacent structures. Calcified pseudoneoplasms of the neuraxis can also mimic other entities such as calcified oligodendrogliomas and meningiomas. Nevertheless, the lesions can usually be strongly suggested at the time of imaging due to a number of fairly unique imaging characteristics. Here, the clinical presentation of a patient with a posterior fossa calcified pseudoneoplasm of the neuraxis is described, along with its imaging and pathologic features.
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Affiliation(s)
- J C Benson
- From the Department of Radiology (J.C.B., C.H.H., J.T.W.)
| | - J Trejo-Lopez
- Laboratory Medicine and Pathology (J.T.-L., J.B.-F.)
| | | | - B Pollock
- Neurologic Surgery (B.P.), Mayo Clinic, Rochester, Minnesota
| | - C H Hunt
- From the Department of Radiology (J.C.B., C.H.H., J.T.W.)
| | - J T Wald
- From the Department of Radiology (J.C.B., C.H.H., J.T.W.)
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8
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Malnik SL, Moor RF, Shin D, Laurent D, Trejo-Lopez J, Dodd W, Yachnis A, Ghiaseddin AP, Fox WC, Roper S. Inflammatory myofibroblastic tumor masquerading as an anterior choroidal artery fusiform aneurysm. Surg Neurol Int 2021; 12:297. [PMID: 34221627 PMCID: PMC8247755 DOI: 10.25259/sni_113_2021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2021] [Accepted: 03/16/2021] [Indexed: 11/12/2022] Open
Abstract
Background: Inflammatory myofibroblastic tumor is a rare, poorly understood tumor that has been found to occur in almost every organ tissue. Its location within the central nervous system is uncommon, and patients tend to present with nonspecific symptoms. Case Description: A female in her eighth decade presented to neurosurgery clinic with complaints of headache and dizziness. Initial imaging was consistent with a low-grade, benign brain lesion in the region of the left choroidal fissure. She was recommended for observation but returned 1 month later with progressive symptoms and doubling of the lesion size. She underwent surgical resection and was found to have an IMT arising from the wall of the left anterior choroidal artery. Conclusion: Intracranial IMT remains a rare and poorly understood entity. The present case demonstrates a novel presentation of IMT in an adult patient and exemplifies the heterogeneity of the disease presentation.
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Affiliation(s)
- Samuel Louis Malnik
- Lillian S. Wells Department of Neurosurgery, University of Florida, Gainesville, Florida, United States
| | - Rachel Freedman Moor
- Lillian S. Wells Department of Neurosurgery, University of Florida, Gainesville, Florida, United States
| | - David Shin
- Lillian S. Wells Department of Neurosurgery, University of Florida, Gainesville, Florida, United States
| | - Dimitri Laurent
- Lillian S. Wells Department of Neurosurgery, University of Florida, Gainesville, Florida, United States
| | - Jorge Trejo-Lopez
- Department of Neuropathology, Mayo Clinic, Rochester, Minnesota, United States
| | - William Dodd
- Lillian S. Wells Department of Neurosurgery, University of Florida, Gainesville, Florida, United States
| | - Anthony Yachnis
- Department of Pathology, University of Florida, Gainesville, United States
| | - Ashley P Ghiaseddin
- Lillian S. Wells Department of Neurosurgery, University of Florida, Gainesville, Florida, United States
| | - W Christopher Fox
- Department of Neurosurgery, Mayo Clinic, Jacksonville, Florida, United States
| | - Steven Roper
- Lillian S. Wells Department of Neurosurgery, University of Florida, Gainesville, Florida, United States
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9
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Toffel S, Velez L, Trejo-Lopez J, Beal SG, Kresak JL. Educational Case: Opportunistic Infections of the Central Nervous System. Acad Pathol 2020; 7:2374289520901809. [PMID: 32064307 PMCID: PMC6993152 DOI: 10.1177/2374289520901809] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2019] [Revised: 10/08/2019] [Accepted: 01/01/2020] [Indexed: 11/17/2022] Open
Abstract
The following fictional case is intended as a learning tool within the Pathology Competencies for Medical Education (PCME), a set of national standards for teaching pathology. These are divided into three basic competencies: Disease Mechanisms and Processes, Organ System Pathology, and Diagnostic Medicine and Therapeutic Pathology. For additional information, and a full list of learning objectives for all three competencies, see http://journals.sagepub.com/doi/10.1177/2374289517715040.1.
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Affiliation(s)
- Steven Toffel
- University of Florida, College of Medicine, Gainesville, FL, USA
| | - Lymaries Velez
- University of Florida, College of Medicine, Gainesville, FL, USA
| | - Jorge Trejo-Lopez
- Department of Pathology, University of Florida Health, Gainesville, FL, USA
| | - Stacy G Beal
- Department of Pathology, University of Florida Health, Gainesville, FL, USA
| | - Jesse L Kresak
- Department of Pathology, University of Florida Health, Gainesville, FL, USA
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10
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Velez L, Toffel S, Trejo-Lopez J, Kresak JL, Beal SG. Educational Case: Etiologies, Mechanisms, and Treatment of Stroke. Acad Pathol 2020; 7:2374289520901817. [PMID: 32047849 PMCID: PMC6985965 DOI: 10.1177/2374289520901817] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2019] [Revised: 11/15/2019] [Accepted: 01/01/2020] [Indexed: 11/16/2022] Open
Abstract
The following fictional case is intended as a learning tool within the Pathology Competencies for Medical Education (PCME), a set of national standards for teaching pathology. These are divided into three basic competencies: Disease Mechanisms and Processes, Organ System Pathology, and Diagnostic Medicine and Therapeutic Pathology. For additional information, and a full list of learning objectives for all three competencies, see http://journals.sagepub.com/doi/10.1177/2374289517715040.1.
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Affiliation(s)
- Lymaries Velez
- University of Florida College of Medicine, Gainesville, FL, USA
| | - Steven Toffel
- University of Florida College of Medicine, Gainesville, FL, USA
| | - Jorge Trejo-Lopez
- Department of Pathology, University of Florida Health, Gainesville, FL, USA
| | - Jesse L Kresak
- Department of Pathology, University of Florida Health, Gainesville, FL, USA
| | - Stacy G Beal
- Department of Pathology, University of Florida Health, Gainesville, FL, USA
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Dawoud F, Lucke-Wold B, Trejo-Lopez J, Yachnis A, Rahman M. An Unusual Cause of Intracerebral Hemorrhage: Clinical Pearls Regarding Primary Angiitis of the Central Nervous System. Neurol Sci Neurosurg 2020; 1:10.47275/2692-093x-109. [PMID: 33205146 PMCID: PMC7668556 DOI: 10.47275/2692-093x-109] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Primary angiitis of the central nervous system (PACNS) is a rare form of vasculitis. It is a diagnosis of exclusion and often diagnosed post mortem on pathologic evaluation. Cerebral angiography can be suggestive, but biopsy is required. Symptoms can vary from headache to focal cranial nerve deficits. On the more severe spectrum, patients can present with ischemic and vary rarely hemorrhagic stroke. We present in this case report key clinical pearls regarding suspected diagnosis. Younger patients with cortical hemorrhages may have PACNS instead of the more common cerebral amyloid angiopathy. Early suspicion may aid in initiating effective treatment as we highlight in the discussion.
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Affiliation(s)
- Fakhry Dawoud
- Quillen College of Medicine, East Tennessee State University, United States
| | - Brandon Lucke-Wold
- Department of Neurosurgery, University of Florida, United States
- Correspondence to: Brandon Lucke-Wold, Department of Neurosurgery, University of Florida, United States;
| | | | - Anthony Yachnis
- Department of Pathology, University of Florida, United States
| | - Maryam Rahman
- Department of Neurosurgery, University of Florida, United States
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12
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Renati S, Yang C, Walsh M, Trejo-Lopez J, Khanna A. Brain and spinal cord infarcts secondary to an atrial-esophageal fistula. Neurol Clin Pract 2017; 7:387-389. [PMID: 29620062 DOI: 10.1212/cpj.0000000000000332] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2016] [Accepted: 10/17/2016] [Indexed: 11/15/2022]
Affiliation(s)
- Swetha Renati
- Departments of Neurology (SR, CY, AK) and Pathology (MW, JT-L), University of Florida, Gainesville
| | - Cui Yang
- Departments of Neurology (SR, CY, AK) and Pathology (MW, JT-L), University of Florida, Gainesville
| | - Meggen Walsh
- Departments of Neurology (SR, CY, AK) and Pathology (MW, JT-L), University of Florida, Gainesville
| | - Jorge Trejo-Lopez
- Departments of Neurology (SR, CY, AK) and Pathology (MW, JT-L), University of Florida, Gainesville
| | - Anna Khanna
- Departments of Neurology (SR, CY, AK) and Pathology (MW, JT-L), University of Florida, Gainesville
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13
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Merlo LJ, Trejo-Lopez J, Conwell T, Rivenbark J. Patterns of substance use initiation among healthcare professionals in recovery. Am J Addict 2013; 22:605-12. [PMID: 24131169 DOI: 10.1111/j.1521-0391.2013.12017.x] [Citation(s) in RCA: 62] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2012] [Revised: 04/03/2012] [Accepted: 10/23/2012] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Substance-related impairment among healthcare professionals has significant public health implications, but little is known regarding factors associated with substance use initiation in this group. METHODS In this study, 105 healthcare professionals (80% male), who ranged in age from 24 to 68 years (M = 47.1 years, SD = 10.2) completed a self-report questionnaire assessing age at first use, education level at first use, means of access to substances upon first use, order of substance use initiation, and reasons for first and continued substance use. Physicians (51%), pharmacists (19.2%), dentists (11.5%), physician assistants (5.8%), and various other allied health professionals (12.7%) participated. RESULTS Results demonstrated that 73.2% of the professionals used tobacco, 90.4% used alcohol, and 64.4% used other drugs before beginning professional school. Reasons for first use of substances paralleled those seen in the general public (e.g., curiosity, peer influence, availability), and differed from reasons for continued substance use (e.g., getting high, addiction, stress management). CONCLUSIONS AND SCIENTIFIC SIGNIFICANCE Given that onset of substance use among health professionals appears to mirror that seen in the general population, their unique treatment success rates likely cannot be solely attributed to later age-of-onset of their substance use disorder. Delaying experimentation with addictive substances and improving efforts at early identification of problematic use are crucial to preventing the development of substance use disorders among healthcare professionals, as well as the public as a whole.
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Affiliation(s)
- Lisa J Merlo
- University of Florida, Gainesville, Florida; Professionals Resource Network, Inc., Fernandina Beach, Florida
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