Progressive cognitive impairment evolving to dementia parallels parieto-occipital and temporal enlargement in idiopathic chronic hydrocephalus: a retrospective cohort study

Little is known regarding progressive enlargement of the ventricular system in symptomatic patients or asymptomatic subjects. Before eventual surgical treatment, we evaluated the clinical and radiological features of an extremely rare group of patients with idiopathic chronic hydrocephalus (ICH) and cognitive impairment evolving to dementia (n = 11), and an extremely rare group of asymptomatic or minimally symptomatic adults (AMSA) with ventricular enlargement (n = 10). We quantified changes over time in the ventricular frontal, occipital, and temporal horns by measuring the Evans' index plus a parieto-occipital ratio and a temporal ratio, and their percentage of progression. Cerebral ventricles expanded over very long term in both demented patients with ICH and in AMSA. In AMSA, frontal enlargement predominated, whereas demented patients showed predominant parieto-occipital (p = 0.00) and temporal (p = 0.00) enlargement that progressed faster than in AMSA (p = 0.00). In ICH, progression of cognitive impairment parallels ventricular parieto-occipital and temporal horn enlargement. Limitations of this study are the retrospective nature, the non-uniform use of neuropsychological tests, the reduced sample size due to the extremely stringent enrollment criteria, the inability to determine the precise rate of progression

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We performed a comprehensive literature search in the PubMed and Scopus data bases on blister-like aneurysms

In response to: Collet-Sicard Syndrome After Jefferson Fracture.

We read with great interest the recent article by Shahrvini et al. concerning Collect-Sicard syndrome after Jefferson fracture.1 The authors present a detailed report of the syndrome in an aged woman after an accidental forward fall with head injury. This case is unique, as we found no geriatric patients with associated Jefferson fracture in our previous review of Collect-Sicard syndrome

Intradural angiomatous meningioma arising from a thoracic nerve root

BACKGROUND: Spinal intradural meningiomas that arise purely from a nerve root without dural attachments are extremely rare. Spinal meningiomas arise from arachnoidal cap cells in the spinal canal, and growth of these tumors exerts pressure on the spinal cord and nerve roots. CASE DESCRIPTION: A patient presented with a lesion at the T3-T4 level that resembled a schwannoma on magnetic resonance imaging. During surgery, the tumor originated from a spinal nerve root. Pathologically, it was an angiomatous meningioma (AM). CONCLUSIONS: In a review of the literature, we discuss the pathogenesis and surgical strategy for diagnosing and treating these extremely rare AM lesions

Lumbar ganglion cyst: Nosology, surgical management and proposal of a new classification based on 34 personal cases and literature review

AIM To analyze different terms used in literature to identify lumbar extradural cysts and propose a common scientific terminology; to elaborate a new morphological classification of this pathology, useful for clinical and surgical purposes; and to describe the best surgical approach to remove these cysts, in order to avoid iatrogenic instability or treat the pre-existing one. METHODS We retrospectively reviewed 34 patients with symptomatic lumbar ganglion cysts treated with spinal canal decompression with or without spinal fixation. Microsurgical approach was the main procedure and spinal instrumentation was required only in case of evident preoperative segmental instability. RESULTS The complete cystectomy with histological examination was performed in all cases. All patients presented an improvement of clinical conditions, evaluated by Visual Analogic Scale and Japanese Orthopaedic Association scoring. CONCLUSION Spinal ganglion cysts are generally found in the lumbar spine. The treatment of choice is the microsurgical cystectomy, which generally does not require stabilization. The need for fusion must be carefully evaluated: Preoperative spondylolisthesis or a wide joint resection, during the operation, are the main indications for spinal instrumentation. We propose the terms "ganglion cyst" to finally identify this spinal pathology and for the first time its morphological classification, clinically useful for all specialists

Emergency decompressive craniectomy after removal of convexity meningiomas

BACKGROUND: Convexity meningiomas are benign brain tumors that are amenable to complete surgical resection and are associated with a low complication rate. The aim of this study was to identify factors that result in acute postoperative neurological worsening after the removal of convexity meningiomas. METHODS: Clinical evaluation and neuroradiological analysis of patients who underwent removal of a supratentorial convexity meningioma were reviewed. Patients were selected when their postoperative course was complicated by acute neurological deterioration requiring decompressive craniectomy. RESULTS: Six patients (mean age: 43.3 years) underwent surgical removal of a supratentorial convexity meningioma. Brain shift (mean: 9.9 mm) was evident on preoperative imaging due to lesions of varying size and perilesional edema. At various times postoperatively, patient consciousness worsened (up to decerebrate posture) with contralateral paresis and pupillary anisocoria. Computed tomography revealed no postoperative hematoma, however, did indicate increased brain edema and ventricular shift (mean: 12 mm). Emergency decompressive craniectomy and brief ventilator assistance were performed in all patients. Ischemia of the ipsilateral posterior cerebral artery occurred in 3 patients and hydrocephalus occurred in 2 patients. Outcome was good in 2, fair in 2, 1 patient had severe disability, and 1 patient died after 8 months. CONCLUSIONS: Brain shift on preoperative imaging is a substantial risk factor for postoperative neurological worsening in young adult patients after the removal of convexity meningiomas. Emergency decompressive craniectomy must be considered because it is effective in most cases. Other than consciousness impairment, there is no reliable clinical landmark to guide the decision to perform decompressive craniectomy; however, brain ischemia may have already occurred

A dataset of Visible – Short Wave InfraRed reflectance spectra collected in–vivo on the dorsal and ventral aspect of arms

Advancement of technology and device miniaturization have made near infrared spectroscopy (NIRS) techniques cost–effective, small–sized, simple, and ready to use. We applied NIRS to analyze healthy human muscles in vivo, and we found that this technique produces reliable and reproducible spectral “fingerprints” of individual muscles, that can be successfully discriminated by chemometric predictive models. The dataset presented in this descriptor contains the reflectance spectra acquired in vivo from the ventral and dorsal aspects of the arm using an ASD FieldSpec® 4 Standard–Res field portable spectroradiometer (350–2500 nm), the values of the anthropometric variables measured in each subject, and the codes to assist access to the spectral data. The dataset can be used as a reference set of spectral signatures of “biceps” and “triceps” and for the development of automated methods of muscle detection

Confocal Imaging at 0.3 THz with depth resolution of a painted wood artwork for the identification of buried thin metal foils

A compact confocal terahertz microscope working at 0.30 THz based on all-solid-state components is used to locate buried thin metal foils in a painted wood artwork. Metal foils are used for decoration, and their precise localization under the pictorial layer is relevant information for conservation scientists and restorers, which can neither be obtained by X-ray radiography nor by spectroscopic imaging in the infrared, as we directly show here. The confocal microscopy principle based on the spatial pinhole concept is here implemented by positioning the first focus of an ellipsoidal reflector at the phase center of horn antennas coupled to Schottky diode detector and emitter mounted in rectangular waveguide blocks, together with an optical beamsplitter. The second focus of the reflector is mechanically scanned inside the sample in three dimensions. The predictions of diffraction theory for a confocal microscope at an imaging wavelength of 1.00 mm with numerical aperture of 0.53 are verified experimentally (1.2 and 2.8 mm for the lateral and the axial resolution, respectively). These values of resolution allow a precise determination of the position of buried metal foils in an ancient piece of art hence making restoration interventions possible

Near-Infrared Transflectance Spectroscopy Discriminates Solutions Containing Two Commercial Formulations of Botulinum Toxin Type A Diluted at Recommended Volumes for Clinical Reconstitution

: Botulinum neurotoxin type A (BoNT-A) is the active substance in pharmaceutical preparations widely used worldwide for the highly effective treatment of various disorders. Among the three commercial formulations of BoNT-A currently available in Italy for neurological indications, abobotulinum A toxin (Dysport\uae, Ipsen SpA, Milano, Italy) and incobotulinum A toxin (Xeomin\uae, Merz Pharma Italia srl, Milano, Italy) differ in the content of neurotoxin, non-toxic protein, and excipients. Clinical applications of BoNT-A adopt extremely diluted solutions (10-6 mg/mL) for injection in the target body district. Near-infrared spectroscopy (NIRS) and chemometrics allow rapid, non-invasive, and non-destructive methods for qualitative and quantitative analysis. No data are available to date on the chemometric analysis of the spectral fingerprints acquired from the diluted commercial formulations of BoNT-A. In this proof-of-concept study, we tested whether NIRS can categorize solutions of incobotulinum A toxin (lacking non-toxic proteins) and abobotulinum A toxin (containing non-toxic proteins). Distinct excipients in the two formulations were also analyzed. We acquired transmittance spectra in the visible and short-wave infrared regions (350-2500 nm) by an ASD FieldSpec 4\u2122 Standard-Res Spectrophotoradiometer, using a submerged dip probe designed to read spectra in transflectance mode from liquid samples. After preliminary spectra pre-processing, principal component analysis was applied to characterize the spectral features of the two BoNT-A solutions and those of the various excipients diluted according to clinical standards. Partial least squares-discriminant analysis was used to implement a classification model able to discriminate the BoNT-A solutions and excipients. NIRS distinguished solutions containing distinct BoNT-A commercial formulations (abobotulinum A toxin vs. incobotulinum A toxin) diluted at recommended volumes for clinical reconstitution, distinct proteins (HSA vs. incobotulinum A toxin), very diluted solutions of simple sugars (lactose vs. sucrose), and saline or water. Predictive models of botulinum toxin formulations were also performed with the highest precision and accuracy