Problemas neurológicos

Epileptic seizure in pediatric patients affects neurodevelopment, and surgical treatment of intractable epilepsy improved comorbidities, but the mechanism is not fully uncovered yet. By measurement of MRI-DTI Fractional Anisotropy (FA) of posterior limb of internal capsule (PIC) of infants, we presented its change by seizure propagation and control in a case of an infant post traumatic epilepsy (PTE) caused by growing skull fracture. Her motor developmental delay and hemiparesis with non-convulsive status epilepticus (NCSE) started 2 months after injury, recovered after surgical repair and seizure control. FA of PIC was lower than normal (0.29 ipsilateral, 0.37 contralateral) had increased to normal range in one week after surgical treatment and seizure control (0.62, 0.66). Comparing with normal time course of FA of motor tract of infant, this dynamic change of FA indicated the effect of seizure control after surgical treatment. As measurement of other brain lesion also showed increased FA in both ipsilateral and contralateral deep white matter, indicated the effect of NCSE for wide network of brain, and influenced infant neuronal development. These result indicated one mechanism why NCSE affected motor developmental delay and surgical intervention for regional infant intractable epilepsy prevented further developmental delay. By handy method of measuring FA of motor tract, we had one possibility to predict motor tract injury in infancy. We also reviewed and discussed about the mechanism of FA increase and decrease in early infancy and how PTE caused FA change.

The prevalence of Parkinson’s disease (PD) in the elderly population exceeds 1% according to recent reports, whereas myasthenia gravis (MG) is much rarer. The expected prevalence of the combination of MG and PD can be grossly estimated to 3 cases per 6 million. To our knowledge, since 1987, 12 cases of concurrent PD and MG have been reported . We report a new case of PD associated with MG with update literature review.

Osteoma of temporal bone is a rare benign neoplasm commonly arising from mastoid bone. Rarely, it may arise from petrous bone in cerebellopontine angle producing sensorineural hearing loss. This article describes computed tomography scan (CT scan) and magnetic resonance imaging (MRI) findings in a rare case of petrous bone osteoid osteoma producing ipsilateral sensorineural deafness.

Acronyms: FD: Fibrous Dysplasia; ABC: Aneurysmal Bone Cyst

Summary: Fibrous dysplasia (FD) of bone is an uncommon skeletal disorder with a broad spectrum of clinical expressions that affects primarily the craniofacial bones. It may be affected by the evolution of lesions over time and by the appearance of superimposed changes, such as aneurysmal bone cysts (ABCs).

We describe an unusual case of a cranial ABC accuring after long evolution of fronto-parietal FD in 16 years old girl. She was operated successfully with total removing of the ABC. After of follow up of 6 months, she was symptom free and CT scan revealed no evidence of recurrence.

Acquired painful or distracting paraesthesia of the lateral two fingers subsequent to a strong mechanical impact to the body can also be elicited clinically by point stimulation around the ipsilateral periscapular region. This neurological (ulnar) demonstration offers an alternative attribution of the etiology for the patient. A simple mechanical procedure that can be self-administered by the patient over several weeks minimizes the symptom and can facilitate sense of control of the unwanted experiences.

Perinatal exposure to pesticides has been associated with neurotoxic changes that may occur during offspring development. This work aimed to evaluate the memory behavior in young and adult offspring from Wistar rats exposed to fipronil in the lactational period. For this, pregnant rats were distributed into two groups (N = 15) constituted as follows: control (Ct) and exposed to fipronil (Fip). Fipronil (Topline®) was administrated to mothers topically, at dose of 1 mg/kg/day, from the 7-14th day of lactation. The offspring memory behavior was assessed using the new object recognition task (ORT) and eight-radial arm maze task (8-RAM). Additionally was quantified the activity of the acetylcholinesterase enzyme (AChE) and made histopathological analysis of brain tissue. Results show persistent decreased memory behavior in offspring exposed to fipronil during lactation period associated with altered AChE activity and morphological changes in the animal's brain tissue. It is concluded that lactational exposure to fipronil provoked damage to the central nervous system (CNS) including altered memory behavior with histopathological and biochemical changes.

Obesity is an important health problem worldwide. The bariatric surgeries (BS) are becoming more frequent due to the high prevalence of obesity. Acute and chronic neurological complications have been reported after this procedure, and can result mainly from nutritional deficiency. There are some reports of peripheral neuropathies due to mechanical or inflammatory mechanisms.

Objective: To report two cases of inflammatory polyneuropathy (PN) after bariatric surgery, without nutritional deficiency.

Case reports: The first patient was a young woman who presents a painful sensorial-motor PN, months after a BS. The other patient was an old man with a pure painful small-fiber PN, one year after the BS. In both patients, there was no nutritional deficiency and blood “screening” for polyneuropathy was unremarkable. The patients underwent a sural nerve biopsy.

Results: The nerve biopsy demonstrated a mild inflammatory infiltrate around epineural vessels and a few axonal and demyelination changes. They were treated with intravenous immunoglobulin with good results.

Conclusion: Although most of the peripheral neuropathies complications after BS are due to nutritional deficiencies, some neuropathies are due to inflammatory involvement of the peripheral nerve. An autoimmune process has been accepted as the underlying pathophysiology in these cases. We think that the nerve biopsy is necessary to support this diagnosis in order to initiate an efficacious treatment.

The answers to two questions: (1) “Do you feel you are the same person as you were before the cerebral event? And (2) When did the sensed presence begin?” are powerful indicators of cerebral dysfunction during the first two or three years subsequent to significant mechanical impacts to the skull even though traditional neurological screening or examinations are within the normal range. These patients also display protracted difficulties with adaptation and rarely have returned to previous employment. Re-attributing the patient’s interpretations of these disturbing experiences from a neurological perspective facilitates adaptation. These interventions might diminish the subjective exacerbations that frequently result in psychiatric referrals years later.

Variations of the musculocutaneous nerve (MC) are not common. Much has been reported on the relationship in between the MC and the coracobrachialis muscle as well as the connections between the MC and median nerve. However, the classification of MC variations according to the origin of MC is seldom seen. We observed and analysed a total of 160 upper limbs from 80 adult cadavers to record anatomical variations in the MC. These variations were classified into five groups depending on the origin of MC: Group 1: The normal type. Classic description found in textbooks (142 arms, 88.75%); Group 2: Multi-branch type. Two or three branches originated from the lateral cord of the brachial plexus, dominating the corresponding muscles. (3 arms, 1.87%); Group 3: Mixed type. The lateral cord of the brachial plexus and median nerve sent branches to constitute the MC respectively. (1 arm, 0.63%); Group 4: Absence type. The MC originated from the median nerve directly. (5 arms, 3.12%); Group 5: Combining type. The MC originated from the lateral cord of the brachial plexus, then gave branches to the corresponding muscles, and finally joined the median nerve (9 arms, 5.63%). The new classification proposed is thought to make easy our clinical practice and to avoid errors caused by anthropometric differences.

Abstract Background: There is a consensus that migraine and epilepsy are comorbid conditions. The novel concept explored and developed in this case series is that of the primacy of headaches in generating seizures in those patients suffering from migraine-triggered epilepsy (i.e., migralepsy). As demonstrated in the five cases descried here, much like the effect of ketogenic-diet on migraine-triggered epilepsy, once the migraine headaches were completely suppressed after adopting daily scheduled opioid therapy the seizures stopped from occurring, but they returned with the recurrence of the migraines once the patients had stopped their daily opiate regimen for any reason. Clinical implications: The above pharmacological scenario is reminiscent of a similar but naturalistic course of events as described in reports concerning the salutary effects of ketogenic diet, or restoration of sleep, in cases of migraine-triggered epilepsy. In all three instances it is the migraines that drive epilepsy, not the other way around, as it is commonly assumed.

Conclusion: Although epilepsy is the more impressive aspect of migraine-triggered convulsions, the cases described in this report point to the primacy of migraine in bring about the whole picture from the start. In every case, seizures were controlled by adopting a treatment plan for preventing the migraines from occurring in the first place, i.e., the daily scheduled opioid treatment for refractory chronic headache. Given the role of cortical spreading depression (CSD) in the genesis of migraine and epilepsy, it is suggested that opiates suppress the development of CSD, thereby prohibiting the progression of migraine to epilepsy.

Objective: The aim of this study was to explore the effect of endothelial progenitor cells (EPCs)-collagen sponge complex on the neovascularization of chronic cerebral ischemia following multiple burr hole (MBH) surgery.

Methods: Bone marrow-derived EPCs from 5 Fisher 344 (F344) inbred rats were cultured and amplified in vitro, then co-cultured to become the EPCs-collagen sponge complex. Chronic cerebral hypo-perfusion was induced in 30 inbred male F344 rats by permanent bilateral internal carotid artery occlusion (BICAO). The MBH operation was performed three days after BICAO surgery. Rats were then randomly divided into 3 groups (n=10 each group); EPCs-collagen sponge complex + MBH; collagen sponge + MBH and MBH group. Either EPCs-collagen sponge complex or collagen sponge was implanted at the burr hole site in the EPCs-collagen sponge complex + MBH and the collagen sponge + MBH group, respectively. Regional cerebral blood flow (rCBF) was measured by Laser Doppler Flowmetry (LDF), EPCs were tracked by fluorescein, and immune-histochemical analysis for the neovascularization was performed 21 days after MBH surgery.

Results: Before the MBH surgery, no differences of rCBF between the EPCs-collagen sponge complex + MBH group, the collagen sponge + MBH group and the MBH alone group (P>0.05) were found. The increase of rCBF in the EPCs-collagen sponge complex + MBH group (20.29 ± 10.21%) was significantly higher when compared with the other two groups 21 days after MBH surgery (7.39 ± 6.85% and 10.32 ± 6.27%, respectively; P<0.05). The amount of new blood vessels in the EPCs-collagen sponge complex + MBH group was also significantly greater than the other two groups (78.2 ± 4.7 vs. 48.7 ± 6.1 vs. 46.9 ± 7.3; P<0.05). The labeled EPCs were incorporated into the endothelial cells of vessels at the burr hole sites.

Conclusion: The EPCs-collagen sponge complex enhances angiogenesis after MBH surgery under chronic cerebral hypo-perfusion condition, and increases the blood flow perfusion in ischemic cerebral tissue.