Balo’s concentric lesions with concurrent features of Schilder’s disease in relapsing multiple sclerosis: neuropathological findings

Atypical inflammatory demyelinating syndromes are rare neurological diseases that differ from multiple sclerosis (MS), owing to unusual clinicoradiological and pathological findings, and poor responses to treatment. The distinction between them and the criteria for their diagnoses are poorly defined due to the lack of advanced research studies. Balo’s concentric sclerosis (BCS) and Schilder’s disease (SD) are two of these syndromes and can present as monophasic or in association with chronic MS. Both variants are difficult to distinguish when they present in acute stages. We describe an autopsy case of middle-aged female with a chronic history of MS newly relapsed with atypical demyelinating lesions, which showed concurrent features of BCS and SD. We also describe the neuropathological findings, and discuss the overlapping features between these two variant

Balo’s concentric lesions with concurrent features of Schilder’s disease in relapsing multiple sclerosis: neuropathological findings

Atypical inflammatory demyelinating syndromes are rare neurological diseases that differ from multiple sclerosis (MS), owing to unusual clinicoradiological and pathological findings, and poor responses to treatment. The distinction between them and the criteria for their diagnoses are poorly defined due to the lack of advanced research studies. Balo’s concentric sclerosis (BCS) and Schilder’s disease (SD) are two of these syndromes and can present as monophasic or in association with chronic MS. Both variants are difficult to distinguish when they present in acute stages. We describe an autopsy case of middle-aged female with a chronic history of MS newly relapsed with atypical demyelinating lesions, which showed concurrent features of BCS and SD. We also describe the neuropathological findings, and discuss the overlapping features between these two variant

Pharmacists’ Knowledge, Attitudes and Practices Towards Herbal Remedies In West Bank, Palestine

Background: There is an increasing trend towards consumption of complementary and alternative herbal products in many parts of the world. Objectives: The purpose of this study was to investigate the knowled - ge and attitudes among pharmacists in West Bank, Palestine towards the use of herbs. Methods: Self-administered questionnaire was designed as the study instrument and distributed among 350 qualified pharmacists working in government and private pharmacies in West Bank, Palestine. Results: The response rate was 82.9% (290/350). The mean age of the pharmacists was 32.9 (SD=6.5) years. The majority of the phar - macist 238 (82.1%) worked in the community pharmacies and their experience in practice ranged from 1 to 26 years. Product package instructions and product representative were the most consulted by the pharmacists (128; 44.2% and 73; 25.2% respectively). General health tonic preparations were the most widely dispensed drugs (142; 48.9%), followed by cough preparations (55; 19.0%) and slimming agents (64; 22.1%). The Majority of pharmacists (195; 67.2%) belie - ved herbal remedies were effective; however, about fifty percent of the pharmacists had concern about their safety. The knowledge of respondents about the indications of herbal medicine was good, but their awareness of interactions, contraindications and adverse effects was inadequate. The majority of Pharmacists (255; 87.9%) believed that herbal product should undergo increased regulation and (215; 74.9%) believed that information available about herbal and natural product isn't adequate

CT Perfusion Imaging as an Early Biomarker of Differential Response to Stereotactic Radiosurgery in C6 Rat Gliomas

BACKGROUND: The therapeutic efficacy of stereotactic radiosurgery for glioblastoma is not well understood, and there needs to be an effective biomarker to identify patients who might benefit from this treatment. This study investigated the efficacy of computed tomography (CT) perfusion imaging as an early imaging biomarker of response to stereotactic radiosurgery in a malignant rat glioma model. METHODS: Rats with orthotopic C6 glioma tumors received either mock irradiation (controls, N = 8) or stereotactic radiosurgery (N = 25, 12 Gy in one fraction) delivered by Helical Tomotherapy. Twelve irradiated animals were sacrificed four days after stereotactic radiosurgery to assess acute CT perfusion and histological changes, and 13 irradiated animals were used to study survival. Irradiated animals with survival \u3e15 days were designated as responders while those with survival ≤15 days were non-responders. Longitudinal CT perfusion imaging was performed at baseline and regularly for eight weeks post-baseline. RESULTS: Early signs of radiation-induced injury were observed on histology. There was an overall survival benefit following stereotactic radiosurgery when compared to the controls (log-rank P CONCLUSIONS: Response to stereotactic radiosurgery was heterogeneous, and early selection of responders and non-responders was possible using CT perfusion imaging. Validation of CT perfusion indices for response assessment is necessary before clinical implementation

Immunolocalization of neurokinin 1 receptor in WHO grade 4 astrocytomas, oral squamous cell and urothelial carcinoma

Neurokinin-1 receptor (NK-1R) induces inflammatory reactions in peripheral tissues but its regulatory effects in target tissues is dependent on receptor signalling. Substance P (SP) has a high affinity for the NK-1R, to which it binds preferentially. We aimed to investigate the expression of NK-1R in World Health Organization (WHO) grade 4 astrocytomas as well as in oral squamous cell carcinoma (OSCC) and urothelial carcinoma, and its association with disease progression.The study included tissue samples from 19 brain astrocytomas, 40 OSCCs and 10 urothelial carcinomas. NK-1R expression was quantitatively assessed in the tumour cells using immunohistochemistry. The relationship between NK-1R expression in astrocytomas and recurrence-free interval has been explored.The results showed that the NK-1R was intensely expressed in patients with WHO grade 4 astrocytoma, OSCC and urothelial carcinoma. However, cases clinically diagnosed as a low-grade cancer showed reduced NK-1R expression.NK-1R is overexpressed in all cases of WHO grade 4 astrocytoma, OSCC and urothelial carcinoma. The ubi-quitous presence of SP/NK-1R complex during tumour development and progression suggests a possible therapeutic key strategy to use NK-1R antagonist as an adjuvant therapy in the future

Infratentorial immature teratoma of congenital origin can be associated with a 20-year survival outcome: a case report and review of literature

Abstract Background Congenital intracranial tumors are very rare and account for less than 2% of all childhood brain tumors. Teratomas constitute about one third to one half of these, predominantly located midline in the supratentorial region. Posterior fossa location rarely occurs and, based on the cases reported in the literature, commonly has a poor prognosis. Case presentation A newborn female, diagnosed prenatally with hydrocephalus, is presented at birth with increasing head circumference and Parinaud’s syndrome. Magnetic resonance imaging scans demonstrated a huge posterior fossa tumor with obstructive hydrocephalus. At surgery, through a suboccipital craniotomy, complete excision was achieved of a histological-proven immature teratoma. The infant received adjuvant chemotherapy for 1 year. She had normal neurological development and remained tumor-free through her 20-year follow-up. Conclusion The authors report this rare case of congenital posterior fossa teratoma with long-term outcome, and the literature is reviewed

Extracranial metastasis of brain glioblastoma outside CNS: Pathogenesis revisited

Abstract Background The most prevalent malignant tumor of the CNS in adults is glioblastoma. Despite undergoing surgery and chemoradiotherapy, the prognosis remains unfavorable, with a median survival period ranging between 15 and 20 months. The incidence of glioblastoma metastasis outside CNS is uncommon with only 0.4%–2% reported rate, compared to other tumors that exhibit a 10% incidence rate of metastasis to the brain. On average, it takes about 11 months from the time of initial diagnosis for the tumor to spread beyond CNS. Consequently, the prognosis for metastatic glioblastoma is grim, with a 6‐month survival rate following diagnosis. Findings The rarity of extracranial metastasis is attributed to the blood–brain barrier and lack of a lymphatic drainage system, although rare cases of hematogenous spread and direct implantation have been reported. The possible mechanisms remain unclear and require further investigation. Risk factors have been widely described, including previous craniotomy or biopsies, ventricular shunting, young age, radiation therapy, prolonged survival time, and tumor recurrence. Due to the lack of understanding about extracranial metastasis of glioblastoma pathogenesis, no effective treatment exists to date. Aggressive chemotherapies are not recommended for metastatic glioblastoma as their side effects may worsen the patient prognosis. Conclusion The optimal treatment for extracranial metastasis of glioblastoma requires further investigation with a wide inclusion of patients. This review discusses the possible causes, factors, and underlying mechanisms of glioblastoma metastasis to different organs

The Potential Effect of the IDH1 Mutation and MGMT Gene Promoter Methylation on the Control of Glioblastoma-Associated Epilepsy in Patients Receiving Anti-Epileptic Agents and Chemotherapies

Objectives:(a) The objective of the study was to assess the control of seizure in glioblastoma patients receiving anti-epileptic drugs and chemotherapies after total resection and its association with O-methylguanine-DNA methyltransferase (MGMT) promoter methylation and the isocitrate dehydrogenase 1 (IDH1) mutation; (b) to determine which anti-epileptic drug exerts the best effective control on glioblastoma-associated epilepsy; and (c) to identify the relationship between seizure control and anti-epileptic drugs with recurrence interval.Methods:This was a retrospective cohort study of patients with postoperative glioblastoma-associated epilepsy. The correlation between IDH1 mutation and MGMT methylation with anti-epileptic drugs, chemotherapy type, seizure control, and recurrence interval was analyzed.Results:The study included 53 patients with glioblastoma-associated epilepsy. IDH1 mutation was present in 20 patients, and MGMT methylation was present in 13 patients. 37 cases received chemoradiotherapy while 16 cases received only radiotherapy. Levetiracetam was the most prescribed anti-epileptic drug (n=36, 60%), and 36 and 16 patients had controlled and uncontrolled seizures, respectively. IDH1 mutation and unmethylated MGMT were significantly present in cases with controlled epilepsy (p<0.05). Levetiracetam showed significantly better seizure control in cases with IDH1 mutation and unmethylated MGMT promotor (p<0.05).Conclusion:(a) Glioblastoma-associated epilepsy can be better controlled in patients with the IDH1 mutation and unmethylated MGMT, (b) levetiracetam was the first-line anti-epileptic drug for controlling seizure, (c) lack of seizure control in glioblastoma patients may not be related to tumor recurrence despite 1-year treatment, and (d) better understanding of the risk factors associated with glioma-associated epilepsy are needed to improve patient quality of life