H-magnetic resonance spectroscopy. diagnostic tool in recurrent headache in systemic lupus erythematosus. a case report

We describe serial MR-spectroscopy studies in a patient with systemic lupus erythematosus and headache. We used MR-spectroscopy to monitor disease activity during periods with and without headache. MR-spectroscopy investigates metabolic alterations and was used to explore the pathophysiological mechanism involved in the complications of systemic lupus erythematosus. Our patient underwent serial conventional MRI and MR-spectroscopy at times of controlled and uncontrolled headache, with or without visual aura. MR-spectroscopy showed an increase in the choline/creatine ratio in thalamus and posterior white matter only during periods of uncontrolled headache with visual aura. Conventional MRI scans were normal at all times. MR-spectroscopy should be used in the diagnosis and follow-up of headache in patients with systemic lupus erythematosus

Neuroplasticity of the visual system after early brain lesion

I possibili mecccanismi di riorganizzazione funzionale dopo lesione cerebrale sono molto complessi e influenzati da un gran numero di fattori. In particolare, quelli che sembrano giocare il ruolo più importante nella determinazione della prognosi, sono i) il timing della lesione, ii) la sua localizzazione e iii) la sua estensione. Fino ad ora, sono stati fatti molti studi riguardanti le correlazioni anatomo-funzionali con le lesioni cerebrali sugli animali o sugli adulti, mentre poco si conosce riguardo ai bambini con lesioni cerebrali (congenite o acquisite) e spesso i dati riportati sono tra loro discordanti. Negli ultimi anni sono state messe a punto, però, tecniche di neuroimaging ad alta definizione in grado di fornirci informazioni più precise sul tipo di lesione, sulla sua estensione e sull’interessamento delle varie aree corticali e sottocorticali coinvolte nel processamento visivo. In questo modo è stato possibile capire meglio la correlazione tra struttura e funzione e il fatto che lo sviluppo normale del sistema visivo dipenda dall’integrità di una ricca rete di connessioni che comprende le radiazioni ottiche e la corteccia visiva primaria, ma anche aree corticali e sottocorticali come quelle dei lobi frontali e temporali o dei gangli della base. Tenendo presenti le conoscenze attuali, nel corso di questo progetto di dottorato, abbiamo cercato di approfondire l’influenza delle lesioni cerebrali, di estensione diversa e avvenute in tempi diversi, sulla riorganizzazione della funzionalità visiva. Ciò è stato possibile grazie alla messa a punto di nuovi test, realizzati in parte in collaborazione con l’Istituto di Neuroscienze-CNR di Pisa, che abbiamo poi potuto somministrare ad un gran numero di bambini (nati a termine o pretermine) con differenti tipi di danno cerebrale. In particolare, il nostro interesse è stato rivolto a due principali aspetti: studiare le abilità visive di bambini con lesioni cerebrali congenite bilaterali (scegliendo come modello di lesione quello della leucomalacia periventricolare) e studiare le capacità visive in bambini con lesioni cerebrali unilaterali avvenute in epoche diverse: lesioni congenite o acquisite. Ciò è stato possibile grazie all’utilizzo di test visivi ben strutturati e standardizzati e al confronto dei risultati ottenuti con i diversi quadri di danno cerebrale riportato alla RMN. Il lavoro di questi anni ci ha permesso di confermare la più alta potenzialità di plasticità in caso di lesioni unilaterali rispetto a quelle bilaterali, riconoscendo alcune strutture chiave nella messa a punto di meccanismi di riorganizzazione adattiva quale per esempio il collicolo superiore. Abbiamo inoltre riscontrato un maggiore potenziale di plasticità in caso di lesioni unilaterali congenite piuttosto che in caso di lesioni unilaterali acquisite seppur precocemente (in età pediatrica). Nel caso di lesione unilaterale acquisita abbiamo tuttavia dimostrato l’efficacia, nella messa a punto di meccanismi di compenso, di trattamenti riabilitativi basati sulla stimolazione multisensoriale (audio-visiva). I nostri studi confermano quindi che i meccanismi di risposta ad un danno avvenuto precocemente sono sicuramente diversi da quelli riscontrati nell’adulto, ma non meno complessi. L’influenza dell’ambiente, il momento il cui avviene la lesione e molti altri fattori giocano un ruolo fondamentale che è ancora lontano dall’essere completamente capito. Per tale motivo, siamo consapevoli di aver fornito solo un piccolo contributo e che è necessario ancora molto lavoro per continuare questa missione infinita che è quella di capire il cervello umano

La importancia del comunity management

Las redes sociales han revolucionado la manera de entender el marketing en la red, por elloes necesario aplicar las nuevas tecnologías y aprovechar las ventajas de la Web 2.0, no sólo se trata esperar visitas sino que hay que salir a relacionarse, buscar información y conversar con los usuarios. En este sentido, aparece el marketing viral y se hacen fuertes las redes sociales con una gran facilidad de expansión e inmediatez, compartir en Facebook o twittear, son términos cada vez más comunes para muchas personas, lo que lo convierte como una gran herramienta para la ejecución del marketing, esto es muy importante en el Community Management, pues se puede mantener una sólida comunicación entre la empresa y el cliente, creando un cambio en el relacionamiento entre productor y el consumidor, teniendo en cuenta y conociendo a fondo la marca, el producto o servicio, la calidad de los mismos y receptividad por parte del público

Serum Cytokine Profile by ELISA in Patients with Echinococcal Cysts of the Liver: A Stage-Specific Approach to Assess Their Biological Activity

To investigate the usefulness of serum cytokine dosage in the clinical management of cystic echinococcosis (CE), we analyzed serum levels of Th1 and Th2 cytokines in patients with hepatic CE in different cyst stages, CE1-2 (active), CE3a-3b (transitional), and CE4-5 (inactive). Ex vivo assessment of Th1 (IFN-γ) and Th2 (IL-4, IL-13, and IL-10) cytokines in sera was carried out using ELISA. IL-10 was undetectable in all serum samples of patients and controls, while a few sera contained measurable amounts of IFN-γ, IL-4, and IL-13. No statistically significant difference was found between the percentages of positive samples for each cytokine and the different groups analyzed (patients/controls, stage, number, location, and size of the cyst, serology, and sex of patients), with the exception of the association of IL-4 and IL-13 with the cyst stage. Overall, this investigation showed many limits of serum cytokine dosage as a marker of biological activity of echinococcal cysts. Because of low sensitivity and lack of specificity of this test, we believe that other ways to evaluate ex vivo biological activity of the cysts should be explored

Impaired Visual Size-Discrimination in Children with Movement Disorders.

Abstract Multisensory integration of spatial information occurs late in childhood, at around eight years ( Gori, Del Viva, Sandini, & Burr, 2008 ). For younger children, the haptic system dominates size discrimination and vision dominates orientation discrimination: the dominance may reflect sensory calibration, and could have direct consequences on children born with specific sensory disabilities. Here we measure thresholds for visual discrimination of orientation and size in children with movement disorders of upper limbs. Visual orientation discrimination was very similar to the age-matched typical children, but visual size discrimination thresholds were far worse, in all eight individuals with early-onset movement disorder. This surprising and counterintuitive result is readily explained by the cross-sensory calibration hypothesis: when the haptic sense is unavailable for manipulation, it cannot be readily used to estimate size, and hence to calibrate the visual experience of size: visual discrimination is subsequently impaired. This complements a previous study showing that non-sighted children have reduced acuity for haptic orientation, but not haptic size, discriminations ( Gori, Sandini, Martinoli, & Burr, 2010 ). Together these studies show that when either vision or haptic manipulation is impaired, the impairment also impacts on complementary sensory systems that are calibrated by that one

Cortical thickness of primary visual cortex correlates with motion deficits in periventricular leukomalacia

Abstract Impairments of visual motion perception and, in particular, of flow motion have been consistently observed in premature and very low birth weight subjects during infancy. Flow motion information is analyzed at various cortical levels along the dorsal pathways, with information mainly provided by primary and early visual cortex (V1, V2 and V3). We investigated the cortical stage of the visual processing that underlies these motion impairments, measuring Grey Matter Volume and Cortical Thickness in 13 children with Periventricular Leukomalacia (PVL). The cortical thickness, but not the grey matter volume of area V1, correlates negatively with motion coherence sensitivity, indicating that the thinner the cortex, the better the performance among the patients. However, we did not find any such association with either the thickness or volume of area MT, MST and areas of the IPS, suggesting damage at the level of primary visual cortex or along the optic radiation

Resting state functional thalamic connectivity abnormalities in patients with post-stroke sleep apnoea: a pilot case-control study

OBJECTIVE: Sleep apnoea is common after stroke, and has adverse effects on the clinical outcome of affected cases. Its pathophysiological mechanisms are only partially known. Increases in brain connectivity after stroke might influence networks involved in arousal modulation and breathing control. The aim of this study was to investigate the resting state functional MRI thalamic hyper connectivity of stroke patients affected by sleep apnoea (SA) with respect to cases not affected, and to healthy controls (HC). PATIENTS AND METHODS: A series of stabilized strokes were submitted to 3T resting state functional MRI imaging and full polysomnography. The ventral-posterior-lateral thalamic nucleus was used as seed. RESULTS: At the between groups comparison analysis, in SA cases versus HC, the regions significantly hyper-connected with the seed were those encoding noxious threats (frontal eye field, somatosensory association, secondary visual cortices). Comparisons between SA cases versus those without SA, revealed in the former group significantly increased connectivity with regions modulating the response to stimuli independently to their potentiality of threat (prefrontal, primary and somatosensory association, superolateral and medial-inferior temporal, associative and secondary occipital ones). Further significantly functionally hyper connections were documented with regions involved also in the modulation of breathing during sleep (pons, midbrain, cerebellum, posterior cingulate cortices), and in the modulation of breathing response to chemical variations (anterior, posterior and para-hippocampal cingulate cortices). CONCLUSIONS: Our preliminary data support the presence of functional hyper connectivity in thalamic circuits modulating sensorial stimuli, in patients with post-stroke sleep apnoea, possibly influencing both their arousal ability and breathing modulation during sleep

Long-term follow-up of adventitial cyst surgical excision in external iliac vein

Adventitial cystic disease of the venous system is an extremely rare condition. Forty-five cases have been described in the literature during the last 70 years, but they may not be representative of the real incidence of this pathologic process. We report a case of an adventitial cyst compressing the right external iliac vein and presenting with edema of the ipsilateral leg. Ultrasound imaging and computed tomography angiography showed the typical features of cystic disease and venous stenosis. Cyst excision was performed with a double surgical access. No perioperative complications were reported. There was no recurrence at 4-year follow-up

Multisensory-Based Rehabilitation Approach: Translational Insights from Animal Models to Early Intervention

Multisensory processes permit combinations of several inputs, coming from different sensory systems, allowing for a coherent representation of biological events and facilitating adaptation to environment. For these reasons, their application in neurological and neuropsychological rehabilitation has been enhanced in the last decades. Recent studies on animals and human models have indicated that, on one hand multisensory integration matures gradually during post-natal life and development is closely linked to environment and experience and, on the other hand, that modality-specific information seems to do not benefit by redundancy across multiple sense modalities and is more readily perceived in unimodal than in multimodal stimulation. In this review, multisensory process development is analyzed, highlighting clinical effects in animal and human models of its manipulation for rehabilitation of sensory disorders. In addition, new methods of early intervention based on multisensory-based rehabilitation approach and their applications on different infant populations at risk of neurodevelopmental disabilities are discussed

Cerebral gray matter volume in patients with chronic migraine: correlations with clinical features

Abstract Background To date, few MRI studies have been performed in patients affected by chronic migraine (CM), especially in those without medication overuse. Here, we performed magnetic resonance imaging (MRI) voxel-based morphometry (VBM) analyses to investigate the gray matter (GM) volume of the whole brain in patients affected by CM. Our aim was to investigate whether fluctuations in the GM volumes were related to the clinical features of CM. Methods Twenty untreated patients with CM without a past medical history of medication overuse underwent 3-Tesla MRI scans and were compared to a group of 20 healthy controls (HCs). We used SPM12 and the CAT12 toolbox to process the MRI data and to perform VBM analyses of the structural T1-weighted MRI scans. The GM volume of patients was compared to that of HCs with various corrected and uncorrected thresholds. To check for possible correlations, patients’ clinical features and GM maps were regressed. Results Initially, we did not find significant differences in the GM volume between patients with CM and HCs (p < 0.05 corrected for multiple comparisons). However, using more-liberal uncorrected statistical thresholds, we noted that compared to HCs, patients with CM exhibited clusters of regions with lower GM volumes including the cerebellum, left middle temporal gyrus, left temporal pole/amygdala/hippocampus/pallidum/orbitofrontal cortex, and left occipital areas (Brodmann areas 17/18). The GM volume of the cerebellar hemispheres was negatively correlated with the disease duration and positively correlated with the number of tablets taken per month. Conclusion No gross morphometric changes were observed in patients with CM when compared with HCs. However, using more-liberal uncorrected statistical thresholds, we observed that CM is associated with subtle GM volume changes in several brain areas known to be involved in nociception/antinociception, multisensory integration, and analgesic dependence. We speculate that these slight morphometric impairments could lead, at least in a subgroup of patients, to the development and continuation of maladaptive acute medication usage