Coexistence of multiple sclerosis and brain tumors: a literature review.

Concurrent development of primary brain tumors and multiple sclerosis is quite rare. Only a few dozens of such comorbidity have been reported. Nevertheless, given the fact that such pathologies are characterized by similar clinical picture and neuroimaging findings, issues about diagnosis and differential diagnosis of such conditions often arise, which makes the problem relevant. A literature review was conducted using PubMed, by selecting articles on concurrent multiple sclerosis and brain tumors, particularly glial origin tumors, over the past 20 years (1989 to 2019). The search was performed in English, Russian, and Ukrainian using the following key words and terms: comorbidity, concomitance, multiple sclerosis, brain tumor, glioma, astrocytoma, glioblastoma.  The analysis included all articles on etiology, pathogenesis, clinical picture, diagnosis, differential diagnosis, neuroimaging, and pathomorphological assessment. After identifying all the articles that met the inclusion criteria and removing duplicate data, 35 literature sources on concurrent primary brain tumors and multiple sclerosis were selected. The conclusion on whether concurrent primary brain tumors and multiple sclerosis develop randomly or have common pathophysiological mechanisms is still under discussion. Potential causes of pathogenesis of both diseases include viral infection, chronic inflammation, neoplastic transformation, and involvement of neurotropic growth factors. The likelihood that two processes, demyelinating and neoplastic, can develop in parallel will never be underestimated. In such cases, strong clinical suspicion arises due to atypical clinical picture characterized by aggressive and rapidly growing neurological symptoms such as aphasia, spastic hemiparesis, epileptic seizures, or signs of intracranial hypertension. In MRI diagnosis, pathological findings such as single lesion of more than 2 cm; mass effect, edema, signal amplification in the form of ring-shaped shadow are the reasons for a more thorough examination and applying additional diagnostic methods: CT, MR spectroscopy, PET, CSF tests to determine oligoclonal antibodies and other markers content, cerebral biopsy. According to the literature, cases of concurrent primary brain tumors and multiple sclerosis are rare though described. Atypical clinical signs, neuroimaging data, and cerebral biopsy which is currently considered as the only method for making accurate diagnosis are helpful in the diagnostic process

Mortality and functional outcome predictors in combat-related penetrating brain injury treatment in a specialty civilian medical institution. Our experience of treatment of 121 wounded people

Background: The combined use of new types of weapons and new types of personal protective equipment has led to changes in the occurrence, nature, and severity of penetrating brain wounds. Methods: This was a prospective analysis of penetrating brain injury in patients who were admitted to Mechnikov Dnipropetrovsk Regional Clinical Hospital (MDRCH), Ukraine, from May 9, 2014 to December 31, 2017. All wounds were sustained during local armed conflict in Eastern Ukraine

Antibacterial Therapy for Purulent-Septic Complications in Patientswith Combat Related Penetrating Craniocerebral Gunshot Wounds

Aim - to evaluate pathogens and their susceptibility to antibiotic therapy (ABT) in combat-related penetrating craniocerebral gunshot wound (PCGW) patients and develop recommendations for treatment of post-traumatic meningoencephalitis. We conducted a prospective analysis of examination and treatment results of 121 patients who were admitted to the Public Institution, Mechnikov Dnipropetrovsk Regional Clinical Hospital, Dnipro, Ukraine, from 25 May 2014, to 31 December 2017, and were successively enrolled in the study. Intracranial purulent-septic complications were diagnosed in 14 (11.6%) patients including eight cases of isolated meningoencephalitis, three cases of meningoencephalitis combined with ventriculitis, two cases of meningoencephalitis combined with ventriculitis and subdural empyema and one case of multiple brain abscesses. In most cases of combat-related craniocerebral wounds, infections are considered nosocomial and typically related to medical procedures and devices. In most cases, the effectiveness of first-line antibiotics was low, and it was often necessary to prescribe broad-spectrum ABT, including those related to secondline antibiotics and reserve drugs, according to the World Health Organisation classification. The use of initial de-escalation of empiric ABT with the broadest-spectrum drugs, mainly as a part of combination therapy for expected gram-positive and gramnegative aerobic and anaerobic infection pathogens, is recommended

Coexistence of multiple sclerosis and brain tumours: Case report and review

In the present report, a review of the literature on the combination of multiple sclerosis and brain tumours is performed. Additionally, the frequency of such combination, possible etiopathogenetic mechanisms, current diagnostic criteria and treatment approaches are reviewed. Furthermore, the case of a 30-year-old man with multiple sclerosis and anaplastic astrocytoma of the right temporal lobe is described in detail. Specifically, the patient underwent a series of tests, including laboratory analyses of blood and cerebrospinal fluid, brain MRI in various modes, MR spectroscopy and excised tumour’s pathohistological and immunohistochemical examination. Results of the tests are reported here. A staged examination and treatment of the patient allowed the researchers to perform a correct diagnosis and obtain a satisfactory functional outcome

Own experience of surgery of the superior sagittal sinus meningiomas causing sinusocclusion

Study objective: Analyzing the surgical treatment outcomes in patients with the parasagittal meningiomas (PM) causing the superior sagittal sinus occlusion (grades VII to VIII as per Bonnal–Brotchi's classification) in two study periods

Prognostic factors of intracranial purulent-septic complications of combat-related gunshot penetrating skull and brain wounds.

Purpose – to ana­lyze the structure of intracranial purulent-septic complications (IPSC), determine the factors influencing development of purulent-septic complications in patients with combat-related gunshot penetrating skull and brain wounds (CRPSBW), determine the effect of intracranial PSC on patients’ outcomes. A prospective analysis of results of exa­mination and treatment of 121 patients was performed. All patients had gunshot penetrating skull and brain wounds sustained in combat conditions during a local armed conflict in the Eastern Ukraine. Evaluation of treatment outcome included analysis of mortality in 1 month (survived/died) and dichotomous Glasgow Outcome Scale (GOS) score in 12 months (favorable/unfavorable outcome). 121 wounded men aged 18 to 56 (average, 34.1±9.1) were included in the study. Intracranial purulent-septic complications (IPSC) were diagnosed in 14 (11.6%) gunshot CRPSBW patients. The following prognostic factors had statistically significantly correlation with the risk of intracranial purulent-septic complications development: wound liquorrhea on admission (p = 0.043), intraventricular hemorrhage (p = 0.007), bone fragments left in the wound (p = 0.0152), and  duration of inflow-outflow wound drainage for more than 3 days (p= 0.0123). Intracranial PSC patients had mortality rate of 50%, and only 14.3% of those patients had a favorable outcome according to GOS score in one year. Presence of intracranial PSC had statistically significant association with mortality rate (p=0.0091) and GOS score in one year (p=0.0001)

Post-traumatic headache. current views on pathophysiological mechanisms of development and clinical specifics (review)

Headache after craniocerebral injury is an urgent problem due to its frequent occurrence, tendency towards chronization, and strong patient disadaptation effect. Despite the significant incidence of post-traumatic headache (the PTHA) and related socioeconomic factors, many fundamental aspects of this problem have not been considered adequately. Therefore, the aim of our review is to highlight key points regarding the pathogenetic mechanisms of development, key clinical features, and strategies for optimal management of PTHA.A literature review was performed using the Pubmed database by selecting articles about post-traumatic headache (PTHA) over 10 years (from 2010 to 2020).The search was performed in English, Russian, and Ukrainian using the following key words and terms: post-traumatic headache, post-traumatic cephalalgia, headache after brain injury, and post-concussion syndrome. All articles with information on etiology, pathogenesis, clinic, diagnosis, differential diagnosis, neuroimaging, pathomorphological evaluation, and treatment strategies for this pathology were included in the analysis. After identifying all the articles that met the inclusion criteria and deleting duplicate data, 46 literature sources on PTHA were selected.According to the International Headache Classification, PTHA is a secondary cephalalgia associated with head and/or neck injury, which develops within 7 days of a craniocerebral injury. A distinction is made between acute and persistent PTHA associated with mild, moderate, and severe injury. To diagnose persistent PTHA, it is sufficient to establish a causal link between the fact of head injury and the duration of pain for 3+ months. It is interestingly that individuals with mild craniocerebral injury have both higher incidence and higher duration and intensity of PTHA compared to those with severe injury. Despite the absence of specific characteristics, several clinical phenotypes of PTHA are distinguished, the most common of which are migraine-like and tensor types. The pathogenetic mechanisms of PTHA development are complex and diverse. Since recently, special attention has been paid to activation of the trigeminovasculo-thalamic system, central sensitization, and GCRPassociated mechanisms that probably play an important role in the PTHA pathogenesis. Modern neuroimaging methods using diffusion-tensor and functional MRI are important in the PTHA diagnosis and differential diagnosis. PTHA treatment requires a multidisciplinary approach and includes a combination of drug and drug-free methods.Despite a long history of PTHA research, the issues concerning diagnostic criteria, pathogenetic mechanisms, clinical features, and strategies, in particular in patients who suffered severe craniocerebral injury, have not been considered properly. The above data indicate the need to clarify many aspects of the studied problem