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Kudelić N, Koprek I, Radoš M, Orešković D, Jurjević I, Klarica M. Predictive value of spinal CSF volume in the preoperative assessment of patients with idiopathic normal-pressure hydrocephalus. Front Neurol 2023; 14:1234396. [PMID: 37869132 PMCID: PMC10585139 DOI: 10.3389/fneur.2023.1234396] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2023] [Accepted: 09/19/2023] [Indexed: 10/24/2023] Open
Abstract
Introduction The pathophysiology, diagnosis, and management of idiopathic normal pressure hydrocephalus (iNPH) remain unclear. Although some prognostic tests recommended in iNPH guidelines should have high sensitivity and high predictive value, there is often no positive clinical response to surgical treatment. Materials and methods In our study, 19 patients with clinical and neuroradiological signs of iNPH were selected for preoperative evaluation and possible further surgical treatment according to the guidelines. MR volumetry of the intracranial and spinal space was performed. Patients were exposed to prolonged external lumbar drainage in excess of 10 ml per hour during 3 days. Clinical response to lumbar drainage was assessed by a walk test and a mini-mental test. Results Twelve of 19 patients showed a positive clinical response and underwent a shunting procedure. Volumetric values of intracranial space content in responders and non-responders showed no statistically significant difference. Total CSF volume (sum of cranial and spinal CSF volumes) was higher than previously published. No correlation was found between spinal canal length, CSF pressure, and CSF spinal volume. The results show that there is a significantly higher CSF volume in the spinal space in the responder group (n = 12) (120.5 ± 14.9 ml) compared with the non-responder group (103.1 ± 27.4 ml; n = 7). Discussion This study demonstrates for the first time that CSF volume in the spinal space may have predictive value in the preoperative assessment of iNPH patients. The results suggest that patients with increased spinal CSF volume have decreased compliance. Additional prospective randomized clinical trials are needed to confirm our results.
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Affiliation(s)
- Nenad Kudelić
- Department of Neurosurgery, General Hospital Varaždin, Varaždin, Croatia
| | - Ivan Koprek
- Department of Neurosurgery, General Hospital Varaždin, Varaždin, Croatia
| | - Milan Radoš
- Department of Pharmacology, Croatian Institute for Brain Research, School of Medicine, University of Zagreb, Zagreb, Croatia
| | - Darko Orešković
- Department of Molecular Biology, Ruđer Bošković Institute, Zagreb, Croatia
| | - Ivana Jurjević
- Department of Pharmacology, Croatian Institute for Brain Research, School of Medicine, University of Zagreb, Zagreb, Croatia
- Department of Neurology, University Hospital Centre Zagreb, Zagreb, Croatia
| | - Marijan Klarica
- Department of Pharmacology, Croatian Institute for Brain Research, School of Medicine, University of Zagreb, Zagreb, Croatia
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Klarica M, Radoš M, Erceg G, Jurjević I, Petošić A, Virag Z, Orešković D. Cerebrospinal fluid micro-volume changes inside the spinal space affect intracranial pressure in different body positions of animals and phantom. Front Mol Neurosci 2022; 15:931091. [PMID: 36187355 PMCID: PMC9518230 DOI: 10.3389/fnmol.2022.931091] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Accepted: 08/09/2022] [Indexed: 11/13/2022] Open
Abstract
Interpersonal differences can be observed in the human cerebrospinal fluid pressure (CSFP) in the cranium in an upright body position, varying from positive to subatmospheric values. So far, these changes have been explained by the Monroe–Kellie doctrine according to which CSFP should increase or decrease if a change in at least one of the three intracranial volumes (brain, blood, and CSF) occurs. According to our hypothesis, changes in intracranial CSFP can occur without a change in the volume of intracranial fluids. To test this hypothesis, we alternately added and removed 100 or 200 μl of fluid from the spinal CSF space of four anesthetized cats and from a phantom which, by its dimensions and biophysical characteristics, imitates the cat cerebrospinal system, subsequently comparing CSFP changes in the cranium and spinal space in both horizontal and vertical positions. The phantom was made from a rigid “cranial” part with unchangeable volume, while the “spinal” part was made of elastic material whose modulus of elasticity was in the same order of magnitude as those of spinal dura. When a fluid volume (CSF or artificial CSF) was removed from the spinal space, both lumbar and cranial CSFP pressures decreased by 2.0–2.5 cm H2O for every extracted 100 μL. On the other hand, adding fluid volume to spinal space causes an increase in both lumbar and cranial CSFP pressures of 2.6–3.0 cm H2O for every added 100 μL. Results observed in cats and phantoms did not differ significantly. The presented results on cats and a phantom suggest that changes in the spinal CSF volume significantly affect the intracranial CSFP, but regardless of whether we added or removed the CSF volume, the hydrostatic pressure difference between the measuring sites (lateral ventricle and lumbar subarachnoid space) was always constant. These results suggest that intracranial CSFP can be increased or decreased without significant changes in the volume of intracranial fluids and that intracranial CSFP changes in accordance with the law of fluid mechanics.
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Affiliation(s)
- Marijan Klarica
- Department of Pharmacology and Croatian Institute for Brain Research, School of Medicine, University of Zagreb, Zagreb, Croatia
- *Correspondence: Marijan Klarica
| | - Milan Radoš
- Department of Pharmacology and Croatian Institute for Brain Research, School of Medicine, University of Zagreb, Zagreb, Croatia
| | - Gorislav Erceg
- Department of Pharmacology and Croatian Institute for Brain Research, School of Medicine, University of Zagreb, Zagreb, Croatia
| | - Ivana Jurjević
- Department of Pharmacology and Croatian Institute for Brain Research, School of Medicine, University of Zagreb, Zagreb, Croatia
| | - Antonio Petošić
- Department of Electroacoustics, Faculty of Electrical Engineering and Computing University of Zagreb, Zagreb, Croatia
| | - Zdravko Virag
- Department of Fluid Mechanics, Faculty of Mechanical Engineering and Naval Architecture, University of Zagreb, Zagreb, Croatia
| | - Darko Orešković
- Department of Molecular Biology, Ruder Bošković Institute, Zagreb, Croatia
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Šimić G, Krsnik Ž, Knezović V, Kelović Z, Mathiasen ML, Junaković A, Radoš M, Mulc D, Španić E, Quattrocolo G, Hall VJ, Zaborszky L, Vukšić M, Olucha Bordonau F, Kostović I, Witter MP, Hof PR. Prenatal development of the human entorhinal cortex. J Comp Neurol 2022; 530:2711-2748. [DOI: 10.1002/cne.25344] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Revised: 04/30/2022] [Accepted: 05/02/2022] [Indexed: 11/11/2022]
Affiliation(s)
- Goran Šimić
- Department of Neuroscience Croatian Institute for Brain Research University of Zagreb Medical School, Zagreb, HR Croatia
| | - Željka Krsnik
- Department of Neuroscience Croatian Institute for Brain Research University of Zagreb Medical School, Zagreb, HR Croatia
| | - Vinka Knezović
- Department of Neuroscience Croatian Institute for Brain Research University of Zagreb Medical School, Zagreb, HR Croatia
| | - Zlatko Kelović
- Department of Anatomy University of Zagreb Medical School, Zagreb, HR Croatia
| | - Mathias Lysholt Mathiasen
- Department of Veterinary and Animal Sciences Faculty of Health Sciences University of Copenhagen, Frederiksberg C, DK Denmark
| | - Alisa Junaković
- Department of Neuroscience Croatian Institute for Brain Research University of Zagreb Medical School, Zagreb, HR Croatia
| | - Milan Radoš
- Department of Neuroscience Croatian Institute for Brain Research University of Zagreb Medical School, Zagreb, HR Croatia
| | - Damir Mulc
- Psychiatric Hospital Vrapče University of Zagreb Medical School, Zagreb, HR Croatia
| | - Ena Španić
- Department of Neuroscience Croatian Institute for Brain Research University of Zagreb Medical School, Zagreb, HR Croatia
| | - Giulia Quattrocolo
- Kavli Institute for Systems Neuroscience and Centre for Neural Computation Norwegian University of Science and Technology Trondheim NO Norway
| | - Vanessa Jane Hall
- Department of Veterinary and Animal Sciences Faculty of Health Sciences University of Copenhagen, Frederiksberg C, DK Denmark
| | - Laszlo Zaborszky
- Center for Molecular and Behavioral Neuroscience Rutgers, The State University of New Jersey Newark New Jersey USA
| | - Mario Vukšić
- Department of Neuroscience Croatian Institute for Brain Research University of Zagreb Medical School, Zagreb, HR Croatia
| | - Francisco Olucha Bordonau
- Department of Medicine School of Medical Sciences Universitat Jaume I Castellón de la Plana ES Spain
| | - Ivica Kostović
- Department of Neuroscience Croatian Institute for Brain Research University of Zagreb Medical School, Zagreb, HR Croatia
| | - Menno P. Witter
- Kavli Institute for Systems Neuroscience and Centre for Neural Computation Norwegian University of Science and Technology Trondheim NO Norway
| | - Patrick R. Hof
- Nash Family Department of Neuroscience and Friedman Brain Institute Icahn School of Medicine at Mount Sinai New York New York USA
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Orešković D, Radoš M, Klarica M. A contribution to the understanding of ocular and cerebrospinal fluid dynamics in astronauts during long-lasting spaceflight. Croat Med J 2021. [PMID: 34472745 PMCID: PMC8491048 DOI: 10.3325/cmj.2021.62.420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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Klarica M, Radoš M, Vukić M, Orešković D. The physiology and pathophysiology of cerebrospinal fluid: new evidence. Croat Med J 2021. [PMID: 34472732 PMCID: PMC8491049 DOI: 10.3325/cmj.2021.62.307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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Radoš M, Živko M, Periša A, Orešković D, Klarica M. No Arachnoid Granulations-No Problems: Number, Size, and Distribution of Arachnoid Granulations From Birth to 80 Years of Age. Front Aging Neurosci 2021; 13:698865. [PMID: 34276348 PMCID: PMC8280770 DOI: 10.3389/fnagi.2021.698865] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [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: 04/22/2021] [Accepted: 06/10/2021] [Indexed: 11/15/2022] Open
Abstract
Introduction: The study aims to quantify changes in the number, size, and distribution of arachnoid granulations during the human lifespan to elucidate their role in cerebrospinal fluid physiology. Material and Methods: 3T magnetic resonance imaging of the brain was performed in 120 subjects of different ages (neonate, 2 years, 10 years, 20 years, 40 years, 60 years, and 80 years) all with the normal findings of the cerebrospinal fluid system (CSF). At each age, 10 male and 10 female subjects were analyzed. Group scanned at neonatal age was re-scanned at the age of two, while all other groups were scanned once. Arachnoid granulations were analyzed on T2 coronal and axial sections. Each arachnoid granulation was described concerning size and position relative to the superior sagittal, transverse, and sigmoid sinuses and surrounding cranial bones. Results: Our study shows that 85% of neonates and 2-year-old children do not have visible arachnoid granulations in the dural sinuses and cranial bones on magnetic resonance imaging. With age, the percentage of patients with arachnoid granulations in the superior sagittal sinus increases significantly, but there is no increase in the sigmoid and transverse sinuses. However, numerous individuals in different age groups do not have arachnoid granulations in dural sinuses. Arachnoid granulations in the cranial bones are found only around the superior sagittal sinus, for the first time at the age of 10, and over time their number increases significantly. From the age of 60 onwards, arachnoid granulations were more numerous in the cranial bones than in the dural sinuses. Conclusion: The results show that the number, size, and distribution of arachnoid granulations in the superior sagittal sinus and surrounding cranial bones change significantly over a lifetime. However, numerous individuals with a completely normal CSF system do not have arachnoid granulations in the dural sinuses, which calls into question their role in CSF physiology. It can be assumed that arachnoid granulations do not play an essential role in CSF absorption as it is generally accepted. Therefore, the lack of arachnoid granulations does not appear to cause problems in intracranial fluid homeostasis.
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Affiliation(s)
- Milan Radoš
- Croatian Institute for Brain Research, University of Zagreb School of Medicine, Zagreb, Croatia
| | - Matea Živko
- Croatian Institute for Brain Research, University of Zagreb School of Medicine, Zagreb, Croatia
| | - Ante Periša
- Croatian Institute for Brain Research, University of Zagreb School of Medicine, Zagreb, Croatia
| | - Darko Orešković
- Department of Molecular Biology, Ruđer Bošković Institute, Zagreb, Croatia
| | - Marijan Klarica
- Croatian Institute for Brain Research, University of Zagreb School of Medicine, Zagreb, Croatia.,Department of Pharmacology, University of Zagreb School of Medicine, Zagreb, Croatia
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Kostović I, Radoš M, Kostović-Srzentić M, Krsnik Ž. Fundamentals of the Development of Connectivity in the Human Fetal Brain in Late Gestation: From 24 Weeks Gestational Age to Term. J Neuropathol Exp Neurol 2021; 80:393-414. [PMID: 33823016 PMCID: PMC8054138 DOI: 10.1093/jnen/nlab024] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [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] [Indexed: 01/10/2023] Open
Abstract
During the second half of gestation, the human cerebrum undergoes pivotal histogenetic events that underlie functional connectivity. These include the growth, guidance, selection of axonal pathways, and their first engagement in neuronal networks. Here, we characterize the spatiotemporal patterns of cerebral connectivity in extremely preterm (EPT), very preterm (VPT), preterm and term babies, focusing on magnetic resonance imaging (MRI) and histological data. In the EPT and VPT babies, thalamocortical axons enter into the cortical plate creating the electrical synapses. Additionally, the subplate zone gradually resolves in the preterm and term brain in conjunction with the growth of associative pathways leading to the activation of large-scale neural networks. We demonstrate that specific classes of axonal pathways within cerebral compartments are selectively vulnerable to temporally nested pathogenic factors. In particular, the radial distribution of axonal lesions, that is, radial vulnerability, is a robust predictor of clinical outcome. Furthermore, the subplate tangential nexus that we can visualize using MRI could be an additional marker as pivotal in the development of cortical connectivity. We suggest to direct future research toward the identification of sensitive markers of earlier lesions, the elucidation of genetic mechanisms underlying pathogenesis, and better long-term follow-up using structural and functional MRI.
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Affiliation(s)
- Ivica Kostović
- From the Croatian Institute for Brain Research, School of Medicine, University of Zagreb, Scientific Centre of Excellence for Basic, Clinical and Translational Neuroscience, Zagreb, Croatia
| | - Milan Radoš
- From the Croatian Institute for Brain Research, School of Medicine, University of Zagreb, Scientific Centre of Excellence for Basic, Clinical and Translational Neuroscience, Zagreb, Croatia.,Polyclinic "Neuron", Zagreb, Croatia
| | - Mirna Kostović-Srzentić
- From the Croatian Institute for Brain Research, School of Medicine, University of Zagreb, Scientific Centre of Excellence for Basic, Clinical and Translational Neuroscience, Zagreb, Croatia.,Department of Health Psychology, University of Applied Health Sciences, Zagreb, Croatia.,Croatian Institute for Brain Research, Center of Research Excellence for Basic, Clinical and Translational Neuroscience, School of Medicine, University of Zagreb, Zagreb, Croatia
| | - Željka Krsnik
- From the Croatian Institute for Brain Research, School of Medicine, University of Zagreb, Scientific Centre of Excellence for Basic, Clinical and Translational Neuroscience, Zagreb, Croatia
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Katušić A, Žunić Išasegi I, Radoš M, Raguž M, Grizelj R, Ferrari F, Kostović I. Transient structural MRI patterns correlate with the motor functions in preterm infants. Brain Dev 2021; 43:363-371. [PMID: 33239233 DOI: 10.1016/j.braindev.2020.11.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Revised: 10/26/2020] [Accepted: 11/03/2020] [Indexed: 10/22/2022]
Abstract
AIM To explore the relationships between transient structural brain patterns on MRI at preterm and at term-equivalent age (TEA) as a predictor of general movements (GMs) and motor development at 1-year corrected age (CA) in very preterm infants. METHODS In this prospective study, 30 very preterm infants (median = 28wks; 16 males) had structural magnetic resonance imaging (MRI) at preterm (median = 31wks + 6d) and at TEA (median = 40wks) and neuromotor assessments. The quality of GMs was assessed by Prechtl's general movements assessment and a detailed analysis of the motor repertoire was performed by calculating a motor optimality score (MOS), both at term age and at 3 months post-term. Motor development at 1-year CA was evaluated with the Infant Motor Profile (IMP). Associations between qualitative MRI findings and neuromotor scores were investigated. RESULTS Abnormal GMs and low motor performance at 1-year CA were associated with the poor visibility of transient structural pattern, that is with sagittal strata. INTERPRETATION Transient structural MRI pattern, sagittal strata, at preterm age is related to the quality of GMs and later motor development in preterm infants. This transient fetal brain compartment may be considered as a component of neurobiological basis for early neuromotor behavior, as expressed by GMs.
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Affiliation(s)
- Ana Katušić
- Scientific Centre of Excellence for Basic, Clinical and Translational Neuroscience, Croatian Institute for Brain Research, University of Zagreb, School of Medicine, Croatia.
| | - Iris Žunić Išasegi
- Scientific Centre of Excellence for Basic, Clinical and Translational Neuroscience, Croatian Institute for Brain Research, University of Zagreb, School of Medicine, Croatia
| | - Milan Radoš
- Scientific Centre of Excellence for Basic, Clinical and Translational Neuroscience, Croatian Institute for Brain Research, University of Zagreb, School of Medicine, Croatia
| | - Marina Raguž
- University Hospital Dubrava, Department of Neurosurgery, University of Zagreb, School of Medicine, Croatia
| | - Ruža Grizelj
- Clinical Hospital Centre Zagreb, Department of Pediatrics, University of Zagreb, School of Medicine, Croatia
| | - Fabrizio Ferrari
- Neonatal Intensive Care Unit, Department of Medical and Surgical Sciences of the Mother, Children and Adults, University of Modena and Reggio Emilia, Modena, Italy
| | - Ivica Kostović
- Scientific Centre of Excellence for Basic, Clinical and Translational Neuroscience, Croatian Institute for Brain Research, University of Zagreb, School of Medicine, Croatia
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Henigsberg N, Savić A, Radoš M, Radoš M, Šarac H, Šečić A, Bajs Janović M, Foro T, Ozretić D, Erdeljić Turk V, Hrabač P, Kalember P. Choline elevation in amygdala region at recovery indicates longer survival without depressive episode: a magnetic resonance spectroscopy study. Psychopharmacology (Berl) 2021; 238:1303-1314. [PMID: 31482202 PMCID: PMC8062352 DOI: 10.1007/s00213-019-05303-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2018] [Accepted: 06/11/2019] [Indexed: 02/02/2023]
Abstract
RATIONALE Depression, with variable longitudinal patterns, recurs in one third of patients. We lack useful predictors of its course/outcome, and proton magnetic resonance spectroscopy (1H-MRS) of brain metabolites is an underused research modality in finding outcome correlates. OBJECTIVES To determine if brain metabolite levels/changes in the amygdala region observed early in the recovery phase indicate depression recurrence risk in patients receiving maintenance therapy. METHODS Forty-eight patients on stable-dose antidepressant (AD) maintenance therapy were analyzed from recovery onset until (i) recurrence of depression or (ii) start of AD discontinuation. Two 1H-MRS scans (6 months apart) were performed with a focus on amygdala at the beginning of recovery. N-acetylaspartate (NAA), choline-containing metabolites (Cho), and Glx (glutamine/glutamate and GABA) were evaluated with regard to time without recurrence, and risks were assessed by Cox proportional hazard modeling. RESULTS Twenty patients had depression recurrence, and 23 patients reached AD discontinuation. General linear model repeated measures analysis displayed three-way interaction of measurement time, metabolite level, and recurrence on maintenance therapy, in a multivariate test, Wilks' lambda = 0.857, F(2,40) = 3.348, p = 0.045. Cho levels at the beginning of recovery and subsequent changes convey the highest risk for earlier recurrence. Patients experiencing higher amygdala Cho after recovery are at a significantly lower risk for depression recurrence (hazard ratio = 0.32; 95% confidence interval 0.13-0.77). CONCLUSION Cho levels/changes in the amygdala early in the recovery phase correlate with clinical outcome. In the absence of major NAA fluctuations, changes in Cho and Glx may suggest a shift towards reduction in (previously increased) glutamatergic neurotransmission. Investigation of a larger sample with greater sampling frequency is needed to confirm the possible predictive role of metabolite changes in the amygdala region early in the recovery phase.
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Affiliation(s)
- Neven Henigsberg
- Croatian Institute for Brain Research, School of Medicine, University of Zagreb, Šalata 12, 10000, Zagreb, Croatia
- University Psychiatric Hospital Vrapče, Zagreb, Croatia
- Croatian Institute for Brain Research, Centre of Excellence for Basic, Clinical and Translational Neuroscience, University of Zagreb School of Medicine, Zagreb, Croatia
| | - Aleksandar Savić
- University Psychiatric Hospital Vrapče, Zagreb, Croatia
- School of Medicine, University of Zagreb, Zagreb, Croatia
| | - Marko Radoš
- Croatian Institute for Brain Research, School of Medicine, University of Zagreb, Šalata 12, 10000, Zagreb, Croatia
- Croatian Institute for Brain Research, Centre of Excellence for Basic, Clinical and Translational Neuroscience, University of Zagreb School of Medicine, Zagreb, Croatia
- University Hospital Centre Zagreb, Zagreb, Croatia
| | - Milan Radoš
- Croatian Institute for Brain Research, School of Medicine, University of Zagreb, Šalata 12, 10000, Zagreb, Croatia
- Croatian Institute for Brain Research, Centre of Excellence for Basic, Clinical and Translational Neuroscience, University of Zagreb School of Medicine, Zagreb, Croatia
| | - Helena Šarac
- Croatian Institute for Brain Research, Centre of Excellence for Basic, Clinical and Translational Neuroscience, University of Zagreb School of Medicine, Zagreb, Croatia
- University Hospital Centre Zagreb, Zagreb, Croatia
| | - Ana Šečić
- Croatian Institute for Brain Research, School of Medicine, University of Zagreb, Šalata 12, 10000, Zagreb, Croatia
- University Hospital Centre 'Sestre Milosrdnice', Zagreb, Croatia
| | - Maja Bajs Janović
- Croatian Institute for Brain Research, Centre of Excellence for Basic, Clinical and Translational Neuroscience, University of Zagreb School of Medicine, Zagreb, Croatia
- University Hospital Centre Zagreb, Zagreb, Croatia
| | - Tamara Foro
- School of Medicine, University of Zagreb, Zagreb, Croatia
| | - David Ozretić
- Croatian Institute for Brain Research, School of Medicine, University of Zagreb, Šalata 12, 10000, Zagreb, Croatia
- Croatian Institute for Brain Research, Centre of Excellence for Basic, Clinical and Translational Neuroscience, University of Zagreb School of Medicine, Zagreb, Croatia
- University Hospital Centre Zagreb, Zagreb, Croatia
| | - Viktorija Erdeljić Turk
- Croatian Institute for Brain Research, Centre of Excellence for Basic, Clinical and Translational Neuroscience, University of Zagreb School of Medicine, Zagreb, Croatia
- University Hospital Centre Zagreb, Zagreb, Croatia
| | - Pero Hrabač
- Croatian Institute for Brain Research, School of Medicine, University of Zagreb, Šalata 12, 10000, Zagreb, Croatia
- Croatian Institute for Brain Research, Centre of Excellence for Basic, Clinical and Translational Neuroscience, University of Zagreb School of Medicine, Zagreb, Croatia
- "Andrija Štampar" School of Public Health, School of Medicine University of Zagreb, Zagreb, Croatia
| | - Petra Kalember
- Croatian Institute for Brain Research, School of Medicine, University of Zagreb, Šalata 12, 10000, Zagreb, Croatia.
- Croatian Institute for Brain Research, Centre of Excellence for Basic, Clinical and Translational Neuroscience, University of Zagreb School of Medicine, Zagreb, Croatia.
- Polyclinic Neuron, Zagreb, Croatia.
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Klarica M, Radoš M, Orešković D. The Movement of Cerebrospinal Fluid and Its Relationship with Substances Behavior in Cerebrospinal and Interstitial Fluid. Neuroscience 2019; 414:28-48. [PMID: 31279048 DOI: 10.1016/j.neuroscience.2019.06.032] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2019] [Revised: 06/21/2019] [Accepted: 06/24/2019] [Indexed: 01/04/2023]
Abstract
The cerebrospinal fluid (CSF) movement and its influence on substance distribution and elimination from the CSF system have been thoroughly analyzed and discussed in the light of the new hypothesis of CSF physiology. As a result, CSF movement is not presented as a circulation, but a permanent rhythmic systolic-diastolic pulsation in all directions. Such movement also represents the main force of substance distribution inside the CSF system. This distribution occurs in all directions, i.e., in the direction of the imagined circulation, as well as in the opposite direction, and depends on the application site and the resident time of tested substance, where longer resident time means longer distribution distance. Transport mechanisms situated on the microvessels inside the central nervous system (CNS) parenchyma play the key role in substance elimination from the CSF and interstitial fluid (ISF) compartments, which freely communicate. If a certain transport mechanism is not available at one site, the substance will be distributed by CSF movement along the CSF system and into the CNS region where that transport mechanism is available. Pharmacological manipulation suggests that the residence time and the substance travel distance along the CSF system depend on the capacity of transport mechanisms situated on CNS blood capillaries. Physiological absorption of the CSF into the venous sinuses and/or lymphatics, due to their small surface area, should be of minor importance in comparison with the huge absorptive surface area of the microvessel network.
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Affiliation(s)
- Marijan Klarica
- Department of Pharmacology and Croatian Institute for Brain Research, School of Medicine University of Zagreb, Zagreb, Croatia.
| | - Milan Radoš
- Department of Pharmacology and Croatian Institute for Brain Research, School of Medicine University of Zagreb, Zagreb, Croatia
| | - Darko Orešković
- Ruđer Bošković Institute, Department of Molecular Biology, Zagreb, Croatia.
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Henigsberg N, Savić A, Radoš M, Šarac H, Radoš M, Ozretić D, Bajs Janović M, Erdeljić Turk V, Šečić A, Kalember P, Hrabač P. Choline and N-acetyl aspartate levels in the dorsolateral prefrontal cortex at the beginning of the recovery phase as markers of increased risk for depressive episode recurrence under different duration of maintenance therapy and after it: a retrospective cohort study. Croat Med J 2018. [PMID: 30394016 PMCID: PMC6240822 DOI: 10.3325/cmj.2018.59.244] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
AIM To evaluate the relationship between the dynamics of proton magnetic resonance spectroscopy (1H-MRS) brain metabolite levels at the beginning of the recovery phase of the index depressive episode and the time to the recurrence of depression. METHODS This retrospective cohort study analyzed the changes in N-acetyl aspartate (NAA), choline (Cho), and glutamate-glutamine in 48 patients with recurrent depression treated with maintenance antidepressant monotherapy at a stable dose. 1H-MRS was performed at the start of the recovery phase and 6 months later. 1H-MRS parameters, index episode descriptors, and depressive disorder course were analyzed by Cox proportional hazards model. RESULTS NAA and Cho decrease six months after the beginning of the recovery period were time-independent risk factors for depressive episode recurrence. Hazard ratio associated with NAA decrease was 2.02 (95% confidence interval 1.06-3.84) and that associated with Cho decrease was 2.06 (95% confidence interval 1.02-4.17). These changes were not related to symptoms severity, as Montgomery-Asberg Depression Scale score remained generally unchanged (mean -0.01; standard deviation 1.6) over the first 6 months of recovery. CONCLUSION Patients receiving maintenance antidepressant therapy after recovery who experience a decrease in NAA or Cho levels early in the recovery phase have a double risk of depressive episode recurrence. Sustained NAA and Cho levels at the beginning of the recovery phase may indicate increased brain resilience conferred by antidepressant therapy, while NAA and Cho decrease may indicate only the trait-related temporal effect of therapy in another stratum of patients.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | - Pero Hrabač
- Pero Hrabač, Croatian Institute for Brain Research, University of Zagreb School of Medicine, 10000 Zagreb, Croatia,
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13
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Žunić Išasegi I, Radoš M, Krsnik Ž, Radoš M, Benjak V, Kostović I. Interactive histogenesis of axonal strata and proliferative zones in the human fetal cerebral wall. Brain Struct Funct 2018; 223:3919-3943. [PMID: 30094607 PMCID: PMC6267252 DOI: 10.1007/s00429-018-1721-2] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2018] [Accepted: 07/18/2018] [Indexed: 12/17/2022]
Abstract
Development of the cerebral wall is characterized by partially overlapping histogenetic events. However, little is known with regards to when, where, and how growing axonal pathways interact with progenitor cell lineages in the proliferative zones of the human fetal cerebrum. We analyzed the developmental continuity and spatial distribution of the axonal sagittal strata (SS) and their relationship with proliferative zones in a series of human brains (8-40 post-conceptional weeks; PCW) by comparing histological, histochemical, and immunocytochemical data with magnetic resonance imaging (MRI). Between 8.5 and 11 PCW, thalamocortical fibers from the intermediate zone (IZ) were initially dispersed throughout the subventricular zone (SVZ), while sizeable axonal "invasion" occurred between 12.5 and 15 PCW followed by callosal fibers which "delaminated" the ventricular zone-inner SVZ from the outer SVZ (OSVZ). During midgestation, the SS extensively invaded the OSVZ, separating cell bands, and a new multilaminar axonal-cellular compartment (MACC) was formed. Preterm period reveals increased complexity of the MACC in terms of glial architecture and the thinning of proliferative bands. The addition of associative fibers and the formation of the centrum semiovale separated the SS from the subplate. In vivo MRI of the occipital SS indicates a "triplet" structure of alternating hypointense and hyperintense bands. Our results highlighted the developmental continuity of sagittally oriented "corridors" of projection, commissural and associative fibers, and histogenetic interaction with progenitors, neurons, and glia. Histogenetical changes in the MACC, and consequently, delineation of the SS on MRI, may serve as a relevant indicator of white matter microstructural integrity in the developing brain.
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Affiliation(s)
- Iris Žunić Išasegi
- Croatian Institute for Brain Research, Centar of Research Excellence for Basic, Clinical and Translational Neuroscience, University of Zagreb, School of Medicine, Zagreb, Croatia
| | - Milan Radoš
- Croatian Institute for Brain Research, Centar of Research Excellence for Basic, Clinical and Translational Neuroscience, University of Zagreb, School of Medicine, Zagreb, Croatia
| | - Željka Krsnik
- Croatian Institute for Brain Research, Centar of Research Excellence for Basic, Clinical and Translational Neuroscience, University of Zagreb, School of Medicine, Zagreb, Croatia
| | - Marko Radoš
- Department of Radiology, Clinical Hospital Center Zagreb, University of Zagreb, School of Medicine, Zagreb, Croatia
| | - Vesna Benjak
- Department of Pediatrics, Clinical Hospital Center Zagreb, University of Zagreb, School of Medicine, Zagreb, Croatia
| | - Ivica Kostović
- Croatian Institute for Brain Research, Centar of Research Excellence for Basic, Clinical and Translational Neuroscience, University of Zagreb, School of Medicine, Zagreb, Croatia.
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Orešković D, Maraković J, Varda R, Radoš M, Jurjević I, Klarica M. New Insight into the Mechanism of Mannitol Effects on Cerebrospinal Fluid Pressure Decrease and Craniospinal Fluid Redistribution. Neuroscience 2018; 392:164-171. [DOI: 10.1016/j.neuroscience.2018.09.029] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2018] [Revised: 09/19/2018] [Accepted: 09/20/2018] [Indexed: 12/31/2022]
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15
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Affiliation(s)
- Darko Orešković
- Ruđer Bošković Institute, Department of Molecular Biology, Zagreb, Croatia; Department of Pharmacology and Croatian Institute for Brain Research, School of Medicine, University of Zagreb, Zagreb, Croatia
| | - Milan Radoš
- Ruđer Bošković Institute, Department of Molecular Biology, Zagreb, Croatia; Department of Pharmacology and Croatian Institute for Brain Research, School of Medicine, University of Zagreb, Zagreb, Croatia
| | - Marijan Klarica
- Ruđer Bošković Institute, Department of Molecular Biology, Zagreb, Croatia; Department of Pharmacology and Croatian Institute for Brain Research, School of Medicine, University of Zagreb, Zagreb, Croatia
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16
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Affiliation(s)
- Darko Orešković
- Ruđer Bošković Institute, Department of Molecular Biology, Zagreb, Croatia; and Department of Pharmacology and Croatian Institute for Brain Research, School of Medicine University of Zagreb, Zagreb, Croatia
| | - Milan Radoš
- Ruđer Bošković Institute, Department of Molecular Biology, Zagreb, Croatia; and Department of Pharmacology and Croatian Institute for Brain Research, School of Medicine University of Zagreb, Zagreb, Croatia
| | - Marijan Klarica
- Ruđer Bošković Institute, Department of Molecular Biology, Zagreb, Croatia; and Department of Pharmacology and Croatian Institute for Brain Research, School of Medicine University of Zagreb, Zagreb, Croatia
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17
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Affiliation(s)
- Darko Orešković
- Darko Orešković, Ruđer Bošković Institute, Department of Molecular Biology, Zagreb, Croatia,
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18
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Nikić I, Radoš M, Frobe A, Vukić M, Orešković D, Klarica M. The effects of lumboperitoneal and ventriculoperitoneal shunts on the cranial and spinal cerebrospinal fluid volume in a patient with idiopathic intracranial hypertension. Croat Med J 2017; 57:293-7. [PMID: 27374831 PMCID: PMC4937228 DOI: 10.3325/cmj.2016.57.293] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Lumboperitoneal (LP) and ventriculoperitoneal (VP) shunts are a frequent treatment modality for idiopathic intracranial hypertension (IIH). Although these shunts have been used for a long time, it is still not clear how they change the total craniospinal CSF volume and what portions of cranial and spinal CSF are affected. This report for the first time presents the results of a volumetric analysis of the total cranial and spinal CSF space in a patient with IIH. We performed an automated segmentation of the cranial and a manual segmentation of the spinal CSF space first with an LP shunt installed and again after the LP shunt was replaced by a VP shunt. When the LP shunt was in place, the total CSF volume was smaller than when the VP shunt was in place (222.4 cm(3) vs 279.2 cm(3)). The difference was almost completely the result of the spinal CSF volume reduction (49.3 cm(3) and 104.9 cm(3) for LP and VP, respectively), while the cranial CSF volume was not considerably altered (173.2 cm(3) and 174.2 cm(3) for LP and VP, respectively). This report indicates that LP and VP shunts in IIH do not considerably change the cranial CSF volume, while the reduction of CSF volume after LP shunt placement affects almost exclusively the spinal part of the CSF system. Our results suggest that an analysis of both the cranial and the spinal part of the CSF space is necessary for therapeutic procedures planning and for an early recognition of numerous side effects that often arise after shunts placement in IIH patients.
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Affiliation(s)
| | | | | | | | | | - Marijan Klarica
- Marijan Klarica, School of Medicine University of Zagreb, Department of Pharmacology and Croatian Institute for Brain Research, Šalata 11, 10 000 Zagreb, Croatia,
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Orešković D, Radoš M, Klarica M. New Concepts of Cerebrospinal Fluid Physiology and Development of Hydrocephalus. Pediatr Neurosurg 2017; 52:417-425. [PMID: 27997915 DOI: 10.1159/000452169] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2016] [Accepted: 09/21/2016] [Indexed: 11/19/2022]
Abstract
The goal of this review is the presentation of the new (Bulat-Klarica-Orešković) hypothesis of cerebrospinal fluid (CSF) physiology and the ensuing new concept of hydrocephalus development in light of this hypothesis. The widely accepted classic hypothesis of CSF physiology and the traditional concept of hydrocephalus are contradicted by numerous experimental and clinical data, which consequently results in unsatisfying clinical treatment and patient recovery. Therefore, the newly presented concept of hydrocephalus development and possible future treatments are discussed. A new definition suggests that hydrocephalus is a pathological state in which CSF is excessively accumulated inside the cranial part of the CSF system, predominantly in one or more brain ventricles as a consequence of impaired hydrodynamics of intracranial fluids between CSF, brain, and blood compartments.
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Affiliation(s)
- Darko Orešković
- Department of Molecular Biology, Ruđer Bošković Institute, Zagreb, Croatia
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20
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Henigsberg N, Šarac H, Radoš M, Radoš M, Ozretić D, Foro T, Erdeljić Turk V, Hrabač P, Bajs Janović M, Rak B, Kalember P. Lower Choline-Containing Metabolites/Creatine (Cr) Rise and Failure to Sustain NAA/Cr Levels in the Dorsolateral Prefrontal Cortex Are Associated with Depressive Episode Recurrence under Maintenance Therapy: A Proton Magnetic Resonance Spectroscopy Retrospective Cohort Study. Front Psychiatry 2017; 8:277. [PMID: 29321747 PMCID: PMC5733547 DOI: 10.3389/fpsyt.2017.00277] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2017] [Accepted: 11/27/2017] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND The aim of this study was to evaluate the relationship between changes in proton magnetic resonance spectroscopy (1H-MRS) parameters at the start of the index episode recovery phase and at recurrence in patients with recurrent depression who were treated with prolonged maintenance therapy. METHODS 1H-MRS parameters were analyzed in 48 patients with recurrent depression who required maintenance therapy with antidepressant medication prescribed by a psychiatrist and who continued with the same antidepressant during the maintenance phase, either to recurrence of depression, completion of the 10-year observation period, or the start of the withdrawal phase (tapering-off antidepressant). N-acetylaspartate (NAA), choline-containing metabolites (Cho), creatine (Cr), and glutamine/glutamate were measured at the start of the recovery phase and 6 months later. RESULTS Recurrent depressive episodes occurred in 20 patients. These individuals had a smaller increase in Cho/Cr after the beginning of the recovery phase compared to the non-recurrent patient group and also exhibited a decreased NAA/Cr ratio. CONCLUSION Sustainable NAA and increased Cho levels at the onset of the recovery phase of the index episode are early markers of antidepressant effectiveness associated with a lower risk of major depressive disorder recurrence. The NAA and Cho changes in the non-recurrent group may be attributable to increased brain resilience, contrary to the transient temporal effect observed in subjects who experienced a depressive episode.
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Affiliation(s)
| | - Helena Šarac
- University Hospital Centre Zagreb, Zagreb, Croatia
| | - Marko Radoš
- School of Medicine, University of Zagreb, Zagreb, Croatia.,University Hospital Centre Zagreb, Zagreb, Croatia
| | - Milan Radoš
- School of Medicine, University of Zagreb, Zagreb, Croatia
| | - David Ozretić
- School of Medicine, University of Zagreb, Zagreb, Croatia.,University Hospital Centre Zagreb, Zagreb, Croatia
| | - Tamara Foro
- School of Medicine, University of Zagreb, Zagreb, Croatia
| | | | - Pero Hrabač
- School of Medicine, University of Zagreb, Zagreb, Croatia
| | | | - Benedict Rak
- University Hospital "Sveti Duh", Zagreb, Croatia
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21
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Klarica M, Jukić T, Miše B, Kudelić N, Radoš M, Orešković D. Experimental Spinal Stenosis in Cats: New Insight in Mechanisms of Hydrocephalus Development. Brain Pathol 2016; 26:701-712. [PMID: 26549012 PMCID: PMC8029224 DOI: 10.1111/bpa.12337] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2015] [Accepted: 11/05/2015] [Indexed: 12/25/2022] Open
Abstract
In our new experimental model of cervical stenosis without inflammation we have tested hypothesis that cranio-spinal communication impairment could lead to hydrocephalus development. Spinal and cranial cerebrospinal fluid (CSF) space separation was obtained with positioning of plastic semiring in epidural space at C2 level in cats. Brain ventricles planimetry, and CSF pressure recording in lateral ventricle (LV) and lumbar subarachnoid space (LSS) were performed in acute and subchronic experiments. In all experiments opening CSF pressures were normal. However, in acute experiments, an infusion of artificial CSF into the LV led to increase of CSF pressure and significant gradient pressure development between LV and LSS due to limited pressure transmission. After 3 or 6 weeks spinal cord atrophy was observed at the site of cervical stenosis, and pressure transmission from LV to LSS was improved as a consequence of spinal tissue atrophy. Planimetry of both the coronal brain slices and the ventricles' surface showed that control ventricular surface was 0.6 ± 0.1% (n = 5), and 1.6 ± 0.2% (n = 4) in animals with subchronic cervical stenosis (P < 0.002). These results support the mentioned hypothesis claiming that CSF volume cranio-spinal displacement impairment could start pathophysiological processes leading to development of hydrocephalus.
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Affiliation(s)
- Marijan Klarica
- Department of Pharmacology and Croatian Institute for Brain ResearchSchool of Medicine University of ZagrebZagrebCroatia
| | - Tomislav Jukić
- Department of OphthalmologyClinical Hospital Center Zagreb, School of Medicine, University of Zagreb
| | - Branko Miše
- University of Zagreb, School of Medicine, University Hospital for Infectious Diseases
| | - Nenad Kudelić
- Department of Pharmacology and Croatian Institute for Brain ResearchSchool of Medicine University of ZagrebZagrebCroatia
| | - Milan Radoš
- Croatian Institute for Brain Research, School of Medicine University of Zagreb
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22
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Vasung L, Lepage C, Radoš M, Pletikos M, Goldman JS, Richiardi J, Raguž M, Fischi-Gómez E, Karama S, Huppi PS, Evans AC, Kostovic I. Quantitative and Qualitative Analysis of Transient Fetal Compartments during Prenatal Human Brain Development. Front Neuroanat 2016; 10:11. [PMID: 26941612 PMCID: PMC4764715 DOI: 10.3389/fnana.2016.00011] [Citation(s) in RCA: 79] [Impact Index Per Article: 9.9] [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: 10/31/2015] [Accepted: 02/01/2016] [Indexed: 02/04/2023] Open
Abstract
The cerebral wall of the human fetal brain is composed of transient cellular compartments, which show characteristic spatiotemporal relationships with intensity of major neurogenic events (cell proliferation, migration, axonal growth, dendritic differentiation, synaptogenesis, cell death, and myelination). The aim of the present study was to obtain new quantitative data describing volume, surface area, and thickness of transient compartments in the human fetal cerebrum. Forty-four postmortem fetal brains aged 13–40 postconceptional weeks (PCW) were included in this study. High-resolution T1 weighted MR images were acquired on 19 fetal brain hemispheres. MR images were processed using in-house software (MNI-ACE toolbox). Delineation of fetal compartments was performed semi-automatically by co-registration of MRI with histological sections of the same brains, or with the age-matched brains from Zagreb Neuroembryological Collection. Growth trajectories of transient fetal compartments were reconstructed. The composition of telencephalic wall was quantitatively assessed. Between 13 and 25 PCW, when the intensity of neuronal proliferation decreases drastically, the relative volume of proliferative (ventricular and subventricular) compartments showed pronounced decline. In contrast, synapse- and extracellular matrix-rich subplate compartment continued to grow during the first two trimesters, occupying up to 45% of telencephalon and reaching its maximum volume and thickness around 30 PCW. This developmental maximum coincides with a period of intensive growth of long cortico-cortical fibers, which enter and wait in subplate before approaching the cortical plate. Although we did not find significant age related changes in mean thickness of the cortical plate, the volume, gyrification index, and surface area of the cortical plate continued to exponentially grow during the last phases of prenatal development. This cortical expansion coincides developmentally with the transformation of embryonic cortical columns, dendritic differentiation, and ingrowth of axons. These results provide a quantitative description of transient human fetal brain compartments observable with MRI. Moreover, they will improve understanding of structural-functional relationships during brain development, will enable correlation between in vitro/in vivo imaging and fine structural histological studies, and will serve as a reference for study of perinatal brain injuries.
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Affiliation(s)
- Lana Vasung
- Department of Developmental Neuroscience, Croatian Institute for Brain Research, School of Medicine, University of ZagrebZagreb, Croatia; Division of Development and Growth, Department of Pediatrics, University of GenevaGeneva, Switzerland
| | - Claude Lepage
- Ludmer Centre for Neuroinformatics, McGill Centre for Integrative Neuroscience, Department of Biomedical Engineering, Montreal Neurological Institute, Montreal, McGill University Montreal, QC, Canada
| | - Milan Radoš
- Department of Developmental Neuroscience, Croatian Institute for Brain Research, School of Medicine, University of Zagreb Zagreb, Croatia
| | - Mihovil Pletikos
- Department of Developmental Neuroscience, Croatian Institute for Brain Research, School of Medicine, University of ZagrebZagreb, Croatia; Department of Neuroscience and Kavli Institute for Neuroscience, Yale School of MedicineNew Haven, CT, USA
| | - Jennifer S Goldman
- Ludmer Centre for Neuroinformatics, McGill Centre for Integrative Neuroscience, Department of Biomedical Engineering, Montreal Neurological Institute, Montreal, McGill University Montreal, QC, Canada
| | - Jonas Richiardi
- Laboratory of Neurology and Imaging of Cognition, Department of Neuroscience, University of Geneva Geneva, Switzerland
| | - Marina Raguž
- Department of Developmental Neuroscience, Croatian Institute for Brain Research, School of Medicine, University of Zagreb Zagreb, Croatia
| | - Elda Fischi-Gómez
- Division of Development and Growth, Department of Pediatrics, University of Geneva Geneva, Switzerland
| | - Sherif Karama
- Ludmer Centre for Neuroinformatics, McGill Centre for Integrative Neuroscience, Department of Biomedical Engineering, Montreal Neurological Institute, Montreal, McGill University Montreal, QC, Canada
| | - Petra S Huppi
- Division of Development and Growth, Department of Pediatrics, University of Geneva Geneva, Switzerland
| | - Alan C Evans
- Ludmer Centre for Neuroinformatics, McGill Centre for Integrative Neuroscience, Department of Biomedical Engineering, Montreal Neurological Institute, Montreal, McGill University Montreal, QC, Canada
| | - Ivica Kostovic
- Department of Developmental Neuroscience, Croatian Institute for Brain Research, School of Medicine, University of Zagreb Zagreb, Croatia
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23
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Maraković J, Vukić M, Radoš M, Chudy D, Klarica M, Orešković D. Monoamine Neurotransmitter Metabolite Concentration as a Marker of Cerebrospinal Fluid Volume Changes. Acta Neurochir Suppl 2016; 122:283-6. [PMID: 27165922 DOI: 10.1007/978-3-319-22533-3_56] [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] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
OBJECTIVE In our previous papers we demonstrated that changes in blood and cerebrospinal fluid (CSF) osmolarity have a strong influence on CSF pressure and volume, which is in accordance with a new proposed hypothesis of CSF physiology. Thus, acute changes in CSF volume should be reflected in the CSF concentration of different central nervous system (CNS) metabolites. METHODS In anesthetized cats (n = 4) we measured the outflow volume of CSF by cisternal free drainage at a negative CSF pressure (-10 cmH2O) before and after the intraperitoneal (i.p.) application of a hypo-osmolar substance (distilled water). In samples of CSF collected at different time intervals (30 min) we measured the concentration of homovanillic acid (HVA). RESULTS In spite of fact that constant CSF outflow volume was obtained after a 30-min period in our model, the concentration of HVA gradually increased over time and became stable after 90 min. After the i.p. application of distilled water the outflow CSF volume increased significantly, whereas the concentration of HVA significantly decreased over 30 min. CONCLUSIONS The results observed suggest that alterations in serum osmolarity change the CSF volume and concentrations of neurotransmitter metabolites because of the osmotic arrival of water from CNS blood capillaries in all CSF compartments.
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Affiliation(s)
- Jurica Maraković
- Department of Neurosurgery, Dubrava University Hospital, Zagreb, Croatia
| | - Miroslav Vukić
- Department of Neurosurgery, Clinical Hospital Centar Zagreb, School of Medicine, University of Zagreb, Zagreb, Croatia
| | - Milan Radoš
- Department of Pharmacology and Croatian Institute for Brain Research, School of Medicine, University of Zagreb, Zagreb, Croatia
| | - Darko Chudy
- Department of Neurosurgery, Dubrava University Hospital, Zagreb, Croatia
| | - Marijan Klarica
- Department of Pharmacology and Croatian Institute for Brain Research, School of Medicine, University of Zagreb, Zagreb, Croatia
| | - Darko Orešković
- Department of Molecular Biology, Ruđer Bošković Institute, Zagreb, Croatia. .,Laboratory of Neurochemistry and Molecular Neurobiology, Department of Molecular Genetics, Ruđer Bošković Institute, Bijenička c. 54, Zagreb, 10 000, Croatia.
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24
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Radoš M, Klarica M, Mučić-Pucić B, Nikić I, Raguž M, Galkowski V, Mandić D, Orešković D. Volumetric analysis of cerebrospinal fluid and brain parenchyma in a patient with hydranencephaly and macrocephaly--case report. Croat Med J 2015; 55:388-93. [PMID: 25165052 PMCID: PMC4157378 DOI: 10.3325/cmj.2014.55.388] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
The aim of this study was to perform for the first time the intracranial volumetric analysis of cerebrospinal fluid (CSF) and brain parenchyma in the supratentorial and infratentorial space in a 30-year-old female patient with hydranencephaly and macrocephaly. A head scan performed using a 3T magnetic resonance was followed by manual segmentation of the brain parenchyma and CSF on T2 coronal brain sections. The volume of CSF and brain parenchyma was measured separately for the supratentorial and infratentorial space. The total volume of the intracranial space was 3645.5 cm3. In the supratentorial space, the volume of CSF was 3375.2 cm3 and the volume of brain parenchyma was 80.3 cm3. In the infratentorial space, the volume of CSF was 101.3 cm3 and the volume of the brain parenchyma was 88.7 cm3. In the supratentorial space, there was severe malacia of almost all brain parenchyma with no visible remnants of the choroid plexuses. Infratentorial structures of the brainstem and cerebellum were hypoplastic but completely developed. Since our patient had no choroid plexuses in the supratentorial space and no obstruction between dural sinuses and CSF, development of hydrocephalus and macrocephaly cannot be explained by the classic hypothesis of CSF physiology with secretion, unidirectional circulation, and absorption as its basic postulates. However, the origin and turnover of the enormous amount of intracranial CSF volume, at least 10-fold larger than normal, and the mechanisms of macroencephaly development could be elucidated by the new hypothesis of CSF physiology recently published by our research team.
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Affiliation(s)
| | - Marijan Klarica
- Marijan Klarica, University of Zagreb, School of Medicine, Department of Pharmacology and Croatian Institute for Brain Research, Šalata 11, 10 000 Zagreb, Croatia,
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25
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Radoš M, Orešković D, Radoš M, Jurjević I, Klarica M. Long lasting near-obstruction stenosis of mesencephalic aqueduct without development of hydrocephalus--case report. Croat Med J 2015; 55:394-8. [PMID: 25165053 PMCID: PMC4157388 DOI: 10.3325/cmj.2014.55.394] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
The aim of this study is to present the five-year longitudinal magnetic resonance imaging (MRI) follow up of a patient with incidental finding of near-obstruction stenosis of the aqueduct of Sylvius due to a large pineal cyst. The patient was scanned 3 times on a 3T MR device using a set of standard structural sequences supplemented with high-resolution constructive interference of steady state (CISS) T2 sequence for precise delineation of the aqueduct of Sylvius and cardiac-gated phase-contrast sequences for the analysis of cerebrospinal fluid (CSF) movement. On all MR scans, the size of the pineal cyst and severity of near-obstruction aqueductal stenosis did not show any morphological changes. There was no significant ventricular enlargement although structural CISS sequence showed a near-obstruction stenosis and cardiac-gated phase-contrast sequences did not detect CSF movement through the aqueduct of Sylvius. Our findings are contradictory to the classic hypothesis of CSF physiology based on secretion, circulation, and absorption of CSF, which states that the impairment of CSF circulation through the aqueduct of Sylvius inevitably leads to a hypertensive hydrocephalus development involving the third and the lateral ventricle. Our research group previously proposed a new hypothesis of CSF physiology, which offers more suitable explanation for such clinical cases.
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Affiliation(s)
| | - Darko Orešković
- Darko Orešković, Rudjer Bošković Institute, Department of Molecular Biology, Bijenička 54, 10 000 Zagreb, Croatia,
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26
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Kostović I, Kostović-Srzentić M, Benjak V, Jovanov-Milošević N, Radoš M. Developmental dynamics of radial vulnerability in the cerebral compartments in preterm infants and neonates. Front Neurol 2014; 5:139. [PMID: 25120530 PMCID: PMC4114264 DOI: 10.3389/fneur.2014.00139] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [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: 04/18/2014] [Accepted: 07/14/2014] [Indexed: 01/06/2023] Open
Abstract
The developmental vulnerability of different classes of axonal pathways in preterm white matter is not known. We propose that laminar compartments of the developing cerebral wall serve as spatial framework for axonal growth and evaluate potential of anatomical landmarks for understanding reorganization of the cerebral wall after perinatal lesions. The 3-T MRI (in vivo) and histological analysis were performed in a series of cases ranging from 22 postconceptional weeks to 3 years. For the follow-up scans, three groups of children (control, normotypic, and preterms with lesions) were examined at the term equivalent age and after the first year of life. MRI and histological abnormalities were analyzed in the following compartments: (a) periventricular, with periventricular fiber system; (b) intermediate, with periventricular crossroads, sagittal strata, and centrum semiovale; (c) superficial, composed of gyral white matter, subplate, and cortical plate. Vulnerability of thalamocortical pathways within the crossroads and sagittal strata seems to be characteristic for early preterms, while vulnerability of long association pathways in the centrum semiovale seems to be predominant feature of late preterms. The structural indicator of the lesion of the long association pathways is the loss of delineation between centrum semiovale and subplate remnant, which is possible substrate of the diffuse periventricular leukomalacia. The enhanced difference in MR signal intensity of centrum semiovale and subplate remnant, observed in damaged children after first year, we interpret as structural plasticity of intact short cortico-cortical fibers, which grow postnatally through U-zones and enter the cortex through the subplate remnant. Our findings indicate that radial distribution of MRI signal abnormalities in the cerebral compartments may be related to lesion of different classes of axonal pathways and have prognostic value for predicting the likely outcome of prenatal and perinatal lesions.
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Affiliation(s)
- Ivica Kostović
- Croatian Institute for Brain Research, University of Zagreb School of Medicine , Zagreb , Croatia
| | | | - Vesna Benjak
- Department of Pediatrics, Clinical Hospital Center Zagreb, University of Zagreb School of Medicine , Zagreb , Croatia
| | - Nataša Jovanov-Milošević
- Croatian Institute for Brain Research, University of Zagreb School of Medicine , Zagreb , Croatia
| | - Milan Radoš
- Croatian Institute for Brain Research, University of Zagreb School of Medicine , Zagreb , Croatia
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Klarica M, Radoš M, Erceg G, Petošić A, Jurjević I, Orešković D. The influence of body position on cerebrospinal fluid pressure gradient and movement in cats with normal and impaired craniospinal communication. PLoS One 2014; 9:e95229. [PMID: 24748150 PMCID: PMC3991613 DOI: 10.1371/journal.pone.0095229] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2013] [Accepted: 03/20/2014] [Indexed: 01/07/2023] Open
Abstract
Intracranial hypertension is a severe therapeutic problem, as there is insufficient knowledge about the physiology of cerebrospinal fluid (CSF) pressure. In this paper a new CSF pressure regulation hypothesis is proposed. According to this hypothesis, the CSF pressure depends on the laws of fluid mechanics and on the anatomical characteristics inside the cranial and spinal space, and not, as is today generally believed, on CSF secretion, circulation and absorption. The volume and pressure changes in the newly developed CSF model, which by its anatomical dimensions and basic biophysical features imitates the craniospinal system in cats, are compared to those obtained on cats with and without the blockade of craniospinal communication in different body positions. During verticalization, a long-lasting occurrence of negative CSF pressure inside the cranium in animals with normal cranio-spinal communication was observed. CSF pressure gradients change depending on the body position, but those gradients do not enable unidirectional CSF circulation from the hypothetical site of secretion to the site of absorption in any of them. Thus, our results indicate the existence of new physiological/pathophysiological correlations between intracranial fluids, which opens up the possibility of new therapeutic approaches to intracranial hypertension.
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Affiliation(s)
- Marijan Klarica
- Department of Pharmacology and Croatian Institute for Brain Research, School of Medicine University of Zagreb, Zagreb, Croatia
| | - Milan Radoš
- Department of Pharmacology and Croatian Institute for Brain Research, School of Medicine University of Zagreb, Zagreb, Croatia
| | - Gorislav Erceg
- Department of Pharmacology and Croatian Institute for Brain Research, School of Medicine University of Zagreb, Zagreb, Croatia
| | - Antonio Petošić
- Department of Electroacoustics, Faculty of Electrical Engineering and Computing University of Zagreb, Zagreb, Croatia
| | - Ivana Jurjević
- Department of Pharmacology and Croatian Institute for Brain Research, School of Medicine University of Zagreb, Zagreb, Croatia
| | - Darko Orešković
- Department of Molecular Biology, Ruđer Bošković Institute, Zagreb, Croatia
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Klarica M, Miše B, Vladić A, Radoš M, Orešković D. "Compensated hyperosmolarity" of cerebrospinal fluid and the development of hydrocephalus. Neuroscience 2013; 248:278-89. [PMID: 23806710 DOI: 10.1016/j.neuroscience.2013.06.022] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2013] [Revised: 05/10/2013] [Accepted: 06/04/2013] [Indexed: 10/26/2022]
Abstract
Acute osmolar loading of cerebrospinal fluid within one lateral ventricle of dogs was examined as a cause of water extraction from the bloodstream and an increase in intracranial pressure. We have shown that a certain amount of (3)H₂O from the bloodstream enters osmotically loaded cerebrospinal fluid significantly faster, hence causing a significant increase in intracranial pressure. The noted phenomenon in which intracranial pressure still significantly increases, but in which the hyperosmolarity of the cerebrospinal fluid is no longer present, was named "compensated hyperosmolarity". In the case of the sub-chronic application of hyperosmolar solutions into cat ventricles, we observed an increase in cerebrospinal fluid volume and a more pronounced development of hydrocephalus in the area of application, but without significant increase in intracranial pressure and without blockage of cerebrospinal fluid pathways. These results support the newly proposed hypothesis of cerebrospinal fluid hydrodynamics and the ability to develop new strategies for the treatment of cerebrospinal fluid-related diseases.
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Affiliation(s)
- M Klarica
- University of Zagreb, School of Medicine, Department of Pharmacology and Croatian Institute for Brain Research, Zagreb, Croatia
| | - B Miše
- University of Zagreb, School of Medicine, University Hospital for Infectious Diseases, Zagreb, Croatia
| | - A Vladić
- Clinical Hospital Sveti Duh, Department of Neurology, Zagreb, Croatia
| | - M Radoš
- University of Zagreb, School of Medicine, Department of Pharmacology and Croatian Institute for Brain Research, Zagreb, Croatia
| | - D Orešković
- Ruđer Bošković Institute, Department of Molecular Biology, Zagreb, Croatia.
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Gabelić T, Adamec I, Mrđen A, Radoš M, Brinar VV, Habek M. Psychotic reaction as a manifestation of multiple sclerosis relapse treated with plasma exchange. Neurol Sci 2011; 33:379-82. [DOI: 10.1007/s10072-011-0712-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2011] [Accepted: 07/13/2011] [Indexed: 11/30/2022]
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