Ancient Schwannoma of the Cauda Equina: our experience and review of the literature

Ancient schwannomas (AS) are exceedingly rare variant of common schwannomas (CS). Only two cases involving the cauda equina region have been previously reported in literature. AS are typically associated with a higher histological degree of degenerative changes (Antoni B areas). It is of peculiar importance, according to our opinion, to outline that, because of their extremely slow growth (which explains the increase of the degenerative changes in respect to the CS) and their typical soft consistency in respect to their standard counterparts, AS usually imply an even better prognosis

Pneumoventricle of Unknown Origin. A Personal Experience and Literature Review of a Clinical Enigma

Pneumocephalus (PC) is an uncommon and life-threatening neurological condition. Air within the ventricular system of the brain is also known as Pneumoventricle (PV). It requires emergency treatments to prevent catastrophic neurological outcomes. Head injury is the most common cause of PV, but there are other well-recognized etiologies in case there is no clear radiological evidence of skull discontinuity. Although this clinical entity has been well described in Literature, our report presents the unique feature of describing a purely ventricular PC without evidence of skull base or cranial vault fracture. Therefore, this case presentation explores mysterious causes of fistulous connections with the atmosphere that may lead to air trapped in and around the cranial vault. The aim of the present paper is to report a case of post-traumatic PV without radiological signs of skull base or convexity fracture in a 72-years-old man, underlining the diagnostic and clinical features, and review the relevant Literature

Anterior-to-Posterior Migration of a Lumbar Disc Sequestration. Surgical Remarks and Technical Notes about a Tailored Microsurgical Discectomy

Extrusion of disc material within the spinal canal complicates up to 28.6% of lumbar disc herniations. Due to the anatomical "corridors" created by the anterior midline septum and lateral membranes, relocation occurs with an anterior and anterolateral axial topography. Posterior migration is an extremely rare condition and anterior-to-posterior circumferential migration is an even rarer condition. Its radiological feature can be enigmatic and since, in more than 50% of cases, clinical onset is a hyperacute cauda equina syndrome, it may imply a difficult surgical decision in emergency settings. Surgery is the gold standard but when dealing with such huge sequestrations, standard microdiscectomy must be properly modified in order to minimize the risk of surgical trauma or traction on the nerve roots

Insights into pharmacotherapy of malignant glioma in adults

Malignant gliomas are the most common primary brain tumors in adults. In the past 10 years significant advances in the treatment of this entity have been made, mainly owing to a better understanding of molecular pathways and biological behavior of the oncogenetic process. This review treats the proven effective and promising approaches with chemotherapy. The standard care for glioblastoma is surgery and concomitant radio- and chemotherapy with temozolomide (TMZ), followed by adjuvant treatment with TMZ. It has been demonstrated to be the most effective treatment protocol. This standardized care allows the application and study of new types of treatment mainly in recurrences and nonresponding patients. Many different approaches have been investigated: the combination of cytotoxic and cytostatic agents as well as molecular targeted therapies have given some encouraging results. Further intensified regimens with TMZ and the local postsurgical application of slow-release polymers loaded with carmustine remain to be defined. The characterization of molecular markers thus becomes particularly important for the stratification of patients raising the possibility to individualize treatment

The choice of gadolinium-based contrast agents: a radiologist’s responsibility between pharmaceutical equivalence and bioethical issues

Contrast Agents (CA) are among the most commonly prescribed drugs worldwide, and are used, with a variety of techniques, to increase and intensify the differences between body tissues and to help radiologist make diagnoses in a fast and precise way. In recent decades, advancements in research have resulted in significant improvements in their composition, and have made them safer and better-tolerated by patients; this notwithstanding, although the currently available CA are generally considered to be safe, their use is not completely without risk. The use of CA faces the radiologist with economic considerations, bioethical dilemmas, and possible profiles of professional responsibility. In fact, to achieve the best results in diagnostic imaging, radiologists have to focus on making an appropriate choice of CA, in consideration of efficacy, safety and appropriateness. Moreover, besides by cost/benefit models widely introduced in health management, radiologists are also influenced by their responsibility of appropriate use for the various diagnostic tests and, finally, the choice of best CA to utilise for each individual patient. Thus, the dilemma of choosing between the best and the most cost-effective tests and procedures is occurring more frequently every day. Different variables, such as the patient, examinations, and technology available, can affect the choice of CA in terms of obtaining the highest diagnostic quality, minimum impact on higher-risk patients, and optimisation of used volumes and injection flow

Letter to editor regarding: "Vertebral bone quality score independently predicts cage subsidence following transforaminal lumbar interbody fusion."

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Immunohistochemical evaluation of aquaporin-4 and its correlation with CD68, IBA-1, HIF-1α, GFAP, and CD15 expressions in fatal traumatic brain injury

Traumatic brain injury (TBI) is one of the leading causes of death and disability worldwide. Our understanding of its pathobiology has substantially increased. Following TBI, the following occur, edema formation, brain swelling, increased intracranial pressure, changes in cerebral blood flow, hypoxia, neuroinflammation, oxidative stress, excitotoxicity, and apoptosis. Experimental animal models have been developed. However, the difficulty in mimicking human TBI explains why few neuroprotective strategies, drawn up on the basis of experimental studies, have translated into improved therapeutic strategies for TBI patients. In this study, we retrospectively examined brain samples in 145 cases of death after different survival times following TBI, to investigate aquaporin-4 (AQP4) expression and correlation with hypoxia, and neuroinflammation in human TBI. Antibodies anti-glial fibrillary acid protein (GFAP), aquaporin-4 (AQP4), hypoxia induced factor-1α (HIF-1α), macrophage/phagocytic activation (CD68), ionized calcium-binding adapter molecule-1 (IBA-1), and neutrophils (CD15) were used. AQP4 showed a significant, progressive increase between the control group and groups 2 (one-day survival) and 3 (three-day survival). There were further increases in AQP4 immunopositivity in groups 4 (seven-day survival), 5 (14-dayssurvival), and 6 (30-day survival), suggesting an upregulation of AQP4 at 7 to 30 days compared to group 1. GFAP showed its highest expression in non-acute cases at the astrocytic level compared with the acute TBI group. Data emerging from the HIF-1α reaction showed a progressive, significant increase. Immunohistochemistry with IBA-1 revealed activated microglia starting three days after trauma and progressively increasing in the next 15 to 20 days after the initial trauma. CD68 expression demonstrated basal macrophage and phagocytic activation mostly around blood vessels. Starting from one to three days of survival after TBI, an increase in the number of CD68 cells was progressively observed; at 15 and 30 days of survival, CD68 showed the most abundant immunopositivity inside or around the areas of necrosis. These findings need to be developed further to gain insight into the mechanisms through which brain AQP4 is upregulated. This could be of the utmost clinicopathological importance

How SARS-Cov-2 can involve the central nervous system. A systematic analysis of literature of the department of human neurosciences of Sapienza University, Italy

Italy is currently one of the countries most affected by the global emergency of COVID-19, a lethal disease of a novel coronavirus renamed as SARS-CoV-2. SARS-CoV-2 shares highly homological sequence with the most studied SARS-CoV, and causes acute, highly deadly pneumonia (COVID-19) with clinical symptoms similar to those reported for SARS-CoV and MERS-CoV. Increasing evidence shows that these coronaviruses are not always confined to the respiratory tract and that they may also neuroinvasive and neurotropic, with potential neuropathological consequences in vulnerable populations. The aim of this study is to predict a likely CNS involvement by SARS-CoV-2 by studying the pathogenic mechanisms in common with other better known and studied coronaviruses with which it shares the same characteristics. Understanding the mechanisms of neuroinvasion and interaction of HCoV (including SARS-Cov-2) with the CNS is essential to evaluate potentially pathological short- and long-term consequences. Autopsies of the COVID-19 patients, detailed neurological investigation, and attempts to isolate SARS-CoV-2 from the endothelium of cerebral microcirculation, cerebrospinal fluid, glial cells, and neuronal tissue can clarify the role played by COVID-19 in CNS-involvement and in the ongoing mortalities as has been in the recent outbreak

Diffuse axonal injury and oxidative stress: A comprehensive review

Traumatic brain injury (TBI) is one of the worldâ\u80\u99s leading causes of morbidity and mortality among young individuals. TBI applies powerful rotational and translational forces to the brain parenchyma, which results in a traumatic diffuse axonal injury (DAI) responsible for brain swelling and neuronal death. Following TBI, axonal degeneration has been identified as a progressive process that starts with disrupted axonal transport causing axonal swelling, followed by secondary axonal disconnection and Wallerian degeneration. These modifications in the axonal cytoskeleton interrupt the axoplasmic transport mechanisms, causing the gradual gathering of transport products so as to generate axonal swellings and modifications in neuronal homeostasis. Oxidative stress with consequent impairment of endogenous antioxidant defense mechanisms plays a significant role in the secondary events leading to neuronal death. Studies support the role of an altered axonal calcium homeostasis as a mechanism in the secondary damage of axon, and suggest that calcium channel blocker can alleviate the secondary damage, as well as other mechanisms implied in the secondary injury, and could be targeted as a candidate for therapeutic approaches. Reactive oxygen species (ROS)-mediated axonal degeneration is mainly caused by extracellular Ca2+. Increases in the defense mechanisms through the use of exogenous antioxidants may be neuroprotective, particularly if they are given within the neuroprotective time window. A promising potential therapeutic target for DAI is to directly address mitochondria-related injury or to modulate energetic axonal energy failure