- Title:Virtual Dark Therapy By Use of Amber Lenses: Potential Outpatient Use In Clients with High Functioning Bipolar I Disorder A Case Report.
- Time :
This case study demonstrates the potential effectiveness of outpatient virtual dark therapy self-treatment for Bipolar I disorder. Patient desired side effect free, nonallopathic outpatient treatment for Bipolar I Disorder. The patient was diagnosed Bipolar I, mild, most recently manic. Previous interventions included medication, routine, exercise, and early symptom recognition. In this study, virtual dark therapy was added using Amber Lenses (AL). The outcome was a reduction in symptoms and termination of medication. Though novel, this preliminary case study deserves more research including additional case studies as a precursor to randomized controlled trials.
Erica Freeman is a licensed clinical social worker. She graduated from Portland State University with her master’s degree in social work in 2000. She has been licensed since 2005 and a private psychotherapist since 2002. Erica worked as a research assistant at Oregon Research Institute for several years prior to becoming a private practitioner. Erica was assisted by Paul Rhode PhD, Jeremy Green PhD, and Gabriel Chandler, LPN. Erica is also a published author. Her married name is Hernandez and she can be reached via her website ericalhernandez.com
- Universidad del Desarrollo
- Title:Impact of COVID-19 Pandemic on Stroke Severity and Mortality in The South-East of Santiago, Chile
- Time :
Background and purpose: Chile has been one of the most affected countries by the COVID-19 pandemic, with one of the highest case rates per population. This has affected the epidemiological behavior of various pathologies. We analyze the impact of the pandemic on the number of admissions due to stroke, its severity and mortality in Santiago, Chile.
Methods: a multicenter observational study based on the records of the 3 hospitals of the South East health service in Santiago, Chile. We recorded the number of patients admitted for ischemic stroke between 01 January 2020 and 30 June 2020. We grouped the cases into two periods, pre-pandemic and pandemic, according to the setting of the state of emergency in Chile.
Results: 431 patients were admitted with ischemic stroke during the study period. There was a non-significant decrease in weekly admissions (17 vs 15 patients per week). No differences were observed in the proportion of patients with medical treatment (p = 0.810), IVT (p = 0.638), EVT (p = 0.503) or IVT + EVT (p = 0.501). There was a statistically significant increase in the NIHSS on admission (7.23 vs 8.78, p = 0.009) and mortality (5.2% vs 12.4%, p = 0.012). In a multivariate analysis the NIHSS on admission was associated with the increased mortality (RR 1.11, CI 1.04-1.19, p = 0.003).
Conclusion: We found an increase in the severity of ischemic stroke on admission and in-hospital mortality during the pandemic period. The main factor to increase in-hospital mortality was the NIHSS on admission.
Andrés Silva is a Professor of Neurology at Pontificia Universidad Católica (Santiago, Chile). He studied neurology at the Pontificia Universidad Católica de Chile and is a vascular neurologist trained at the Germans Trias i Pujol Hospital (Barcelona, Spain). He is the head of the stroke unit at Sótero del Río Hospital (Santiago, Chile)
- The Academic College of Tel-Aviv Yaffo, Israel
- Title:Post Corona Experience of Recovered Covid-19 Severe Patients During Rehabilitation
- Time :
Post Corona experience of recovered covid-19 severe patients during rehabilitation
Preliminary data from research indicate that severe acute respiratory syndrome coronavirus (COVID19) infection is associated with neurological and neuropsychiatric illness. Up to 80% of patients
surviving acute respiratory failure after receiving mechanical ventilation in the ICU experience new
or worsened physical, cognitive and/or mental health impairments that persist beyond hospital
discharge, collectively known as the post- intensive care syndrome.
This study preliminary focuses on the lived experience of patients admitted to the rehabilitation ward
after recovering from ventilation. Semi structured qualitative interviews were conducted with 10
patients to understand their experience form being hospitalized in ICU and receiving mechanical
ventilation. Interview shed life on the individual psychological experience and the meaning making
process following the neurological rehabilitation period.
Avital Gershfeld-Litvin, PhD, medical psychologist, and supervisor, working at the Division
of Neurological Rehabilitation, The Chaim Sheba Medical Center, Tel Hashomer, Israel. Lecturer at
the Medical Psychology Graduate Program, Tel Aviv -Yaffo Academic College, Israel. Research
areas: grief and bereavement process following loss related to illness and other medical conditions
(i.e., breast loss, perinatal loss, disability).
- Title:Mycotoxins Cause Amyotrophic Lateral Sclerosis.
- Time :
Amyotrophic Lateral Sclerosis(ALS) remains a terminal disease without an established etiology for the majority of patients. The dominant theory of ALS before 1970’s was the presence of poisons. One of the primary means of treating patients with a toxic exposure has been plasma exchange, but plasma exchange of ALS patients failed to alter the clinical course. The failure of plasma exchange assumes the patient is no longer exposed to the poison. If the toxic exposure continues after plasma exchange, then plasma exchange alone would fail. The world food supply is contaminated by opportunistic fungi that release mycotoxins. There is mounting evidence of the profound neurologic and immunologic toxicity of the most common mycotoxins. Every ALS patient examined had evidence of a toxic exposure. Treatment with antifungals specific to the most common opportunistic fungi led to improvement in laboratory evidence of a poisoning. The pathology of the common mycotoxins mimics the pathology reported in ALS patients. Along with the profound neurotoxicity of mycotoxins, there is profound immune toxicity. If mycotoxins are involved causing ALS, then the immunotoxicity of mycotoxins could be responsible for the recalcitrance of therapy reported in ALS. New forms of treatment for immune deficits, immune tolerance and immune evasion could remarkably improve the treatment of ALS patients.
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- Brigham and Women’s Hospital, USA
- Title:How Self-Reported Hot Flashes May Relate to Affect, Cognitive Performance and Sleep
- Time :
Purpose: To explain the controversy about whether midlife women who self-report hot flashes have relatively increased affective symptoms, poor cognitive performance or worse sleep. Methods: Retrospective data from 88 women seeking relief from bothersome day and night hot flashes were submitted to mixed linear regression modeling to find if estimated hot flashes, as measured by Women’s Health Questionnaire (WHQ) items or diary-documented hot flashes recorded daily were associated with each other or with affective, cognitive or sleep measures. Results: Subjects averaged 6.3 daytime diary-documented hot flashes and 2.4 nighttime diary-documented hot flashes per 24 h. Confounder-controlled, diary-documented hot flashes but not estimated hot flashes were associated with increased Leeds anxiety scores (F = 4.9; t = 2.8; p = 0.01) and Leeds depression scores (3.4; 2.5; 0.02), decreased Stroop Color–Word test performance (9.4; 3.5; 0.001), increased subjective sleep disturbance (effect size = 0.83) and increased objective sleep disturbance(effect size = 0.35). Hot flash effects were small to moderate in size. Univariate but not multivariate analyses revealed that all hot flash measures were associated with all affect measures. Different measures of hot flashes associated differently with affect, cognition and sleep. Only nighttime diary-documented hot flashes consistently correlated with any affect measures in multivariate analyses.
Conclusions: Reported inconsistencies in menopause study outcomes may be due to the use of differing measures for hot flashes, affect, cognition and sleep. This problem impedes forging a consensus on whether hot flashes correlate with neuropsychological symptoms.
Quentin Regestein is a clinician-researcher interested in menopause and transcranial brain stimulation. He currently develops applications to improve US health care delivery.
Joan Friebely’s research has focused on menopause’s psychological effects and second-hand smoking.
Isaac Schiff is a clinician-researcher who has done prize-winning menopausal research. He co-founded founded the North American Menopause Society and is Editor-in-Chief of the journal Menopause.
- University of Missouri, Columbia
- Title:Enhanced Recovery: Post-Operative Delirium and Potential Interventions
- Time :
Enhanced recovery programs have been developed to improve patient’s post-operative outcomes through pre-op education and preconditioning, modification of anesthetic techniques intraoperatively and multimodal pain management techniques post-operatively. The overall goal of these protocols is to decrease the use of medical interventions and time in the hospital. With a growing elderly population requiring surgical intervention, the impact of post-operative delirium and cognitive dysfunction is a growing problem and significantly increases the cost of care. The collaborative efforts of Neurology and Anesthesiology to identify patients who are at risk and modify anesthetic techniques are the next evolution for enhanced recovery protocols to improve patient outcomes and increase efficient delivery of care.
Quinn L. Johnson, MD, MBA is the Chair of the Department of Anesthesiology at the University of Missouri-Columbia, and serves as the Russel B. and Mary D. Sheldon Professor in Anesthesiology. He also serves as adjunct faculty in the School of Business where he teaches management classes on healthcare as it relates to business. Clinically he has advanced training in acute pain management and ultrasound guided regional nerve block techniques. Clinically he works at the Missouri Orthopaedic Institute. He recently served as the president of the Missouri Society of Anesthesiology and is currently a member of the American Society of Anesthesiology’s committee on Academic Anesthesiology. He has received grants, published and presented in numerous journals and conferences, on a variety of topics including enhanced recovery and post-operative delirium in the elderly.
- Amity University, India
- Title:Measuring Recorded Effect of Sound Wave on Human Brain through Music Pattern Recognition Using Digital Signal Processing
- Time :
Objective of the system is to measure the effect of sound wave / music sample(s) on human brain while concentrating on study and reading some texts. The idea is to discover some interesting measure from the recorded image-base, by Magnetic Resonance Imaging (MRI) / Computer Tomography(CT) scan, through correspondence with the metadata of music sample i.e. music spectrum analyzed through Digital Signal Processing and further to relate them transitively with the physical feedback given by the person who is under testing.
In the model formulation of the problem, first the parameters / performance indicators in Music Information Retrieval (MIR) are identified causing maximum impact while reading any content attentively. The concentration level is tried to be identified through MRI / CT Scan through follow up testing. The reading content can either be texts or images since music is already in the background. If reading content includes videos / music then there will be clash of interest because of the presence of background music. The data has to be collected from each and every training music sample and measured correspondence through images of brain developing a tabular form including the information of each parameters and correspondence through MRI / CTS images. The parametric identification is done using Digital Signal Processing toolbox in MATLAB and the MRI / CTS images are to be corresponded through Digital Image Processing. This dynamical system initially employs generate and test mechanism with variant music sample and measure impact on small population of human being producing a sound warehouse. Trends are then analyzed and discovered from this data warehouse by means of Data Mining techniques by constructing the association rule. This is first step towards construction of rule base. Once the rule base is built, the knowledge base is constituted and hence Production System is developed. This correspondence, when established with a reasonable degree of aspiration from the sound warehouse, it is applied to examine how much accurately the association rule is working for various test cases. The System is trained with extended music database so as to correspond the song type and attention level which may yield different result for different human being. Parametric identification of stylometry plays an important role.
In the solution process, the system is tested with the similar song type and the texts / contents on different human being. The evaluation / assessment of reading content of various human beings with background music and without background music are put under a comparative study.
The limitation of the system is the feedback of the human being regarding their own perceived attention level is taken into consideration in pursuit of perfection. However, resolution can be made with the results obtained through comparative study.
The major motivation behind this work is the earlier work to develop cognitive system that can treat patient of non –surgical category (both psychological and non-psychological) using Music Therapy treatment convention. The successful application of it may well open the scope of utilizing music as an effective tool in various human needs viz. relaxation, temperament restoration, therapeutic needs and concentration building of children with learning, emotive and developmental difficulties.
Keywords: Knowledge base, Magnetic Resonance Imaging (MRI), Music Information Retrieval (MIR), Production System, Rule base, Singer Recognition.
Dr. Somsubhra Gupta is Associate Professor at AIASK, Amity University, Kolkata. He was Adjunct Professor in the Department of Computer Science & Engineering, and erstwhile Dean of Faculty, DIT and Dean of Academic Affairs, HOD of the Department of Computer Science and Engineering and the Department of Information Technology, of JIS College of Engineering (An autonomous Institution) for one and half decade. Prior to this institute, he was in Asansol Engineering College and Murshidabad College of Engineering and Technology. He has graduated from University of Calcutta, obtained his Master’s Degree from Indian Institute of Technology, Kharagpur and received the Ph.D. from University of Kalyani. He has two decades of experience, publications of 85 research papers in journals and proceedings (IEEE Xplore, Science Direct, Springer etc.) 4 Book Chapters, having 3 Research Projects as Principal Investigator / Project Coordinator, Editor of 2 Proceeding books, and 3 Patent published (as Inventor). He received Research Excellence Award by NESIN, Science Father in 2020, provided Honorary Rosalind Membership by London Journal Press in 2020, Bharat VidyaShiromani Award by the International Business Council, New Delhi, 2016 and Outstanding Faculty Award by the Centre for Advanced Research and Design (CARD), VIF Chennai in July 2015.
Couple of his papers won Best Paper Awards. He was selected in GSA P4 rank by the United Nations Commission for Population Development in 2010. He attended NAFSA World Conference of International educators at St. Louis, Missouri, USA in 2013. He was the TEQIP Coordinator of the Institution In World Bank sponsored TEQIP Phase II Subcomponent 1.2 for PG and demand-driven Research Development and Innovation. He is in the Editorial Board / Technical Programme Committee of number of forums.
- Santa Casa Hospital of Porto Alegre, Brazil
- Title:Single Burr-Hole Extended Transforaminal Approach for Concurrent Endoscopic Surgery in the Third Ventricle Posterior to the Foramen of Monro and Ventriculostomy: Clinical Series and Planning Steps
- Time :
Objective. For endoscopic surgery of lesions in the middle to posterior third ventricle that frequently require a third ventriculostomy during the same procedure, an extended transforaminal approach (ETFA) via a single burr hole is presented. Aims of the study were to define a safe transchoroidal entry zone, to
calculate the optimal position of the burr hole, and to report the clinical results from a patient series.
Patients and Methods. Preclinical part with cadaver study (n=6 hemispheres) and retrospective MRI assessment of cases with occlusive hydrocephalus (n=30 sides). Retrospective review of clinical series of concurrent third ventricle surgery (14 cystic lesions and 11 tumor cases) and third ventriculostomy for feasibility of the endoscopic ETFA procedures and clinical outcome.
Results. The anatomical study revealed a foramen of Monro diameter of 5mm (4-7mm) and a safe entry zone of additional 5mm (3-6mm). On MRI of patients with enlarged third ventricle, the foramen of Monro diameter was 7mm (3-11mm) and the safe entry zone 6mm (3-12 mm) for the ETFA. The optimal burr hole
position was 22mm (10-30mm) lateral to the midline and 8mm (27 to -23mm) precoronal. Clinically, the ETFA was feasible in 24/25 cases. The safe entry zone was sufficient in 16 cases; the anterior septal vein was transectioned in 9 cases without clinical consequences.
Conclusion. According to our data, concurrent endoscopic surgery in the middle to posterior third ventricle and ventriculostomy are feasible via a single burr hole and a transchoroid extension of the transforaminal approach. Precise preoperative planning is recommended for assessing the individual nuances of this approach.
Keywords: ventricular endoscopy, transchoroidal approach, minimally invasive, tumors
Physician specialized in Neurosurgery, MHSc in Neurosurgery at Federal University of São Paulo (UNIFESP), PhD in Medical Sciences at Federal University of Rio Grande do Sul (UFRGS), acting on the topics of Neurosciences, Artificial Intelligence, and Oncology.
Google Scholar: https://scholar.google.com.br/citations?view_op=list_works&hl=pt-BR&user=GB-j0lcAAAAJ
ResearcherID : https://www.researchgate.net/scientific-contributions/2173655494_Carlos_Brusius
- University Hospital Nuestra Señora de Candelaria, Spain
- Title:Rhombencephalitis Associated with Anti-NMDA Receptor Antibodies: An Unusual Presentation.
- Time :
Anti-NMDA receptor encephalitis mainly affects young people, often requiring a high clinical suspicion for diagnosis. The typical clinical presentation includes psychiatric symptoms, movement
disorders, seizures and dysautonomia. We present a highly unusual case where the rhombencephalon was exclusively affected, leading to a clinical expression of a pancerebellar syndrome.
A 21 year-old male individual lacking any previous relevant medical history, was hospitalised as a result of a progressive clinical picture of dizziness, cephalalgy and binocular diplopia. Physical examination showed lethargy, limited right-eye abduction, bilateral appendicular ataxia and general hyporeflexia. Complementary tests showed there was a mononuclear pleocytosis, high protein levels in the cerebrospinal fluid, and MRI revealed abnormal T2/FLAIR hyperintensity localised in pons and cerebellar hemispheres. Despite having received a treatment of intravenous immunoglobulins, the patient presented seizures and a paracerebellar syndrome. Thus, another cycle of high concentration of both immunoglobulins and intravenous steroids was required for eight days to observe a decrease of symptoms.
Further analyses conducted by an external laboratory showed the presence of anti-NMDA receptor antibodies in the cerebrospinal fluid, as well as a secondary surface antibody that still remains unknown.
This case increases the clinical spectrum of anti-NMDA receptor encephalitis. Other studies have described several cases where anti-NMDAr antibodies have caused syndromes affecting the brain stem or the cerebellum. However, solely presenting a rhombencephalitis as an initial symptom has barely been documented so far. Additionally, the impact that the secondary surface antibody that was detected in the cerebrospinal liquid might have on the patient’s pathology remains unknown. Nonetheless, several studies suggest that 4-7.5% of anti-NMDAr encephalitis could present coexistent antibodies, as this area of study continues to expand.
Miguel Solé-Sabater graduated in Medicine from the University of La Laguna in 2018. He now works as a resident of Neurology in Hospital Universitario Nuestra Señora de Candelaria, Tenerife.
He is also doing a PhD in the University of La Laguna, where he focuses on neurophysiology, by studying brain biorhythms and transcranial magnetic stimulation.
- University of Concepción, Chile
- Title:Covered-Stent Treatment of an Extracranial Internal Carotid Artery Pseudoaneurysm in a 3 Years-Old Child with 12-Years Follow-Up. Case Report.
- Time :
Introduction: Extracranial internal carotid artery (ICA) pseudoaneurysms in children, although uncommon, are life-threatening. Covered stents are a good alternative treatment, as they avoid the risk of open surgery and preserve the internal carotid artery. Long- term outcomes were unknown until recently. Report: In August 2008, a 3-years-old child was treated with a covered stent for a pseudoaneurysm in the extracranial ICA. A long-term follow up is presented. Results: The child was discharged with full recovery and without neurological sequelae. He has been followed-up and has remained asymptomatic for 12 years, with CTA- confirmed internal carotid artery patency, without deformation or evidence of significant re- stenosis. Conclusion: This the first report of the long-term outcome of a covered stent in a child treated at 3 years of age, with a 12-year follow-up. The good performance of the covered stent in this case reinforces its adoption as a first-line option in the treatment of extracranial ICA pseudoaneurysms in children.
Prof. Roberto Sánchez, MD Professor of Surgery
Faculty of Medicine- University of Concepción- CHILE Fellow of the American College of Surgeons
Ancien Resident Etranger des Hopitaux de Paris
Membre Asociee Etranger Société de Chirurgie Vasculaire et Endovasculaire de Langue Francaise (SCVE)
Non-european Membership European Society of Vascular and Endovascular Surgery (ESVS)
- Santa Casa of Sao Paulo, Brazil
- Title:Chemotherapy Induced Reversible Cerebral Vasoconstriction Syndrome
- Time :
Reversible Cerebral Vasoconstriction Syndrome (RCVS) is a neurological syndrome characterized by a severe acute headache, maximal at onset, associated with diffuse segmental constriction of cerebral arteries. My colleagues and I have recently reported a case of a 28-year-old woman diagnosed with RCVS, with typical clinical and radiological findings, after receiving the first dose of intrathecal (IT) cytarabine for the treatment of diffuse large B-cell lymphoma. Neurotoxicityis a common side effect of chemotherapy and symptoms differ according to drug class and dosage. Cytarabine has been associated with an array of neurotoxic effects, including myelopathy, peripheral neuropathy, seizures, encephalopathy and acute cerebellar syndrome, but cerebral vasospasm is not a
frequently reported complication. Throughout an extensive literature review, six previously reported cases of RCVS following chemotherapy were found, all in children. The research did not identify other reports in the adult population. As the mechanism of chemotherapy-associated neurotoxicity is not well known, specific therapeutic and prevention strategies are a challenge and have not yet been developed.
Dr. Natalia Mendes is a clinical neurologist practicing in Brazil. She earned her medical degree from the Federal University of Parana (Brazil) and University Bordeaux Segalen (France). Her residency was at Santa Casa de Sao Paulo Hospital (Brazil), and she is completing her training with fellowship at the University of Sao Paulo in neuroimmunology. Dr. Mendes has authored articles in neurology journals and presented several works at locals and international conferences. She has a particular interest in neuroimmunology and in the care of neurologic complex cases and hopes to continue contributing to different fields of neuroscience.
- University of Iceland, Iceland
- Title:Sudden Unique Self-Similarity Between Human and Pre-Neuronal Intracellular Mass-Societies: Giant Extra-Individual T-Strings and the Forming of Citizens
- Time :
This presentation is mainly based on long standing biomathematical behavioral research recently described in “T-patterns, external memory and mass-societies in proteins and humans: In an eye-blink the naked ape became a string-controlled citizen” https://doi.org/10.1016/j.physbeh.2020.113146 (free open access).
Since the early 1970’s, this project was much inspired by N. Tinbergen, K. Lorenz, and K. von Frisch’s research on animal and human social behavior winning them the Nobel Prize in Physiology or Medicine in 1973, the first in Ethology, the biology of behavior. Insects were still the smallest animals studied so none were components of any others and there was no mention of nanoscale actors nor self-similarity.
The focus here has been on defining mathematical pattern types for behavior analysis, mainly the T-pattern, a hierarchical and self-similar pattern recurring with significant translation symmetry in time and on strings (T-strings) and developing (since the late 70’s) adequate computational algorithms and software (THEMETM, patternvision.com) used for their detection in humans, animals, neurons, and proteins. This has finally drawn attention to unique structural similarities between intracellular protein mass-societies and those extremely recent of humans; a self-similar hierarchy of T-pattern based mass-societies.
Nanoscale phenomena have recently become visible to humanity uncovering a highly patterned pre-neural world where billions of years ago an RNA world invented extra-individual purely informational T-strings, i.e., DNA, and soon there was only the world of DNA-based world of walking and working protein mass-societies (“Cell Cities”). Billions of years later, human mass-societies are the first and only animal societies to reach self-similarity with these DNA/protein mass-societies of every cell in their bodies, by also inventing extra-individual purely informational T-strings, i.e., TEXT and bit T-strings, and now nearly all human life is TEXT-based and mass-social with external-memory (first using clay, now mostly silicon) allowing explosive growth of human knowledge, science, and technology separating human life dramatically from any other known forms of life.
Magnus S. Magnusson, PhD, Emeritus Research Professor, founder, and director of the Human Behavior Laboratory, School of Health Sciences, University of Iceland. Author of the T-system and THEMETM (PatternVision). Co-directed project “DNA analysis with Theme”. Keynotes in biology, neuroscience, mathematics, science of religion, proteomics, A.I., and nanoscience. Deputy Director 1983-1988 in the Museum of Mankind of the National Museum of Natural History, Paris. Repeatedly, invited Professor at the University of Paris V, VIII & XIII. Since 1995 in formal collaboration between 32 European and American universities initiated at the University of Paris V, Sorbonne, based on “Magnusson’s analytical model”. Main interest: mass-societies and bio-mathematical self-similarity between nano and human scales.
- University hospital of Coventry and Warwickshire, U.K
- Title:Spinal Cord Tumor Presenting as Idiopathic Intracranial Hypertension-a Misdiagnosis: Case Report
- Time :
Background: Idiopathic Intracranial hypertension (IIH), is a relatively uncommon disorder characterised by raised intracranial pressure without any established pathogenesis. The symptoms are essentially of headache, nausea, vomiting, visual loss and findings of papilledema. Very rarely a spinal tumor is seen as the cause of the symptoms.
Case description: We present a 26 year old male, with BMI of 24.6, who is otherwise fit and well, that was admitted from the Emergency department with 6 days history of headache, one episode of vomiting, photophobia, neck pain, low grade fever, confusion and blurring of vision. He was initially treated by Neurologist with broad spectrum antibiotics and antiviral for suspicion of meningio – encephalitis. Later lumbar puncture with cerebro spinal fluid (CSF) analysis and MRI brain demonstrated no infective pathology. Patient had persistent headache and blurry vision and input from Ophthalmology revealed Left VI nerve palsy and bilateral papilledema. Neurologist made a differential diagnosis of IIH and venous sinus thrombosis and started him on Acetazolamide.
He did not have any significant past medical history and his BMI was not typical for IIH. The CT venogram showed no obstructive pathology or any stenosis. The lumbar puncture revealed opening pressure of 34cm H20. Reconfirmation of CSF results showed no infective aetiology and the antibiotics and antivirals were stopped. IIH was provisionally diagnosed and he was referred to Neurosurgeons for CSF diversion.
Investigation: Due to unusual presentation, we advised a full cranio-spinal MRI and it revealed a spinal cord lesion attached to the filum terminale at L1/2 level with significant compression to the thecal sac, conus and cauda equina with spinal CSF flow impairment at that level
Treatment: He underwent a Posterior T12 to L2 laminectomy and complete excision of the tumor under Neurophysiological monitoring. He improved significantly within one week of his operation with headaches and vision getting better and objectively the papilledema was also better as confirmed by the Ophthalmologist. He was discharged home and till his first follow up after 6 weeks is neurologically much better with headaches completely resolved and vision almost back to normal. The histopathology came as Ependymoma WHO grade 2.
Conclusion: For someone presenting with IIH, a spinal tumor should be considered in the differential diagnosis, especially when there is no dural venous sinus anomaly and patient refractory to medical treatment.
Keywords: Idiopathic Intracranial hypertension (IIH), Cerebro spinal fluid (CSF), Papilledema, Intradural Extramedullary
I, Debasish Hajra, am a Medical graduate from India and have been working in the Neurosurgery speciality in the UK for over 17 years. After completing my Membership Royal College of Surgeons (MRCS), I have worked as a registrar and subsequently got promotion as a senior registrar in Neurosurgery. I currently work in University Hospitals Coventry and Warwickshire, U.K. I have also passed my EANS (European Association of Neurosurgery Societies) exam and cleared my Fellowship Royal College of Surgeons (FRCS) part I exam. I have special interest in Spine and Skull base.
- University of New South Wales, Australia
- Title:Cerebral Cortex of Diprotodontids- A Quantitative Analysis and Comparison with the Eutherians
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The Diprotodontids which are a highly successful group of Australian metatherians with a strikingly diverse range of ecological niches from nectar and pollen feeders to grazers and folivores. They range from a small- brained nectar feeding species (Tarsipes) to the large-brained grazing and browsing species (macropods). Their diversity in all aspects of their life provides an opportunity to examine and analyse how the cerebral cortex has expanded in an adaptive radiation quite independent of that occurring among eutherians. We have used the Nelson Brain collection and online resources to perform a quantitative analysis of the isocortex, hippocampal formation and olfactory structures in diprotodontids. The scaling relationship between iso- and periallocortical grey matter and brain size, and between subcortical white matter and iso- and periallocortex grey matter, are both almost identical among diprotodontids and eutherians. By contrast, the relationship between gyrification and brain size is strikingly different between diprotodontids and eutherians, with gyrification being much lower for a given brain size among the diprotodontids, although gyrification is much more varied among macropods than other diprotodontids. The scaling of iso- and periallocortical volume with dorsal striatal and dorsal thalamic volume is almost identical among the diprotodontids and eutherians, but the claustrum is smaller, and amygdala larger, for a given brain size among diprotodontids than eutherians. The hippocampal formation and central olfactory areas (anterior olfactory region and piriform cortex) both scale more steeply with brain size among diprotodontids compared to eutherians. Our findings suggest that, although white matter scaling is identical among all therians, there are significant differences between diprotodontids and eutherians in the way that cortical folding and expansion of allocortical structures occurs with brain enlargement.
- Ozel Bağlar Hospital, Turkey
- Title:COVID-19: Endogenous Retinoic Acid Theory and Retinoic Acid Depletion Syndrome
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This study presents two new concepts and definitions to the medical literature. One of those is “endogenous retinoic acid theory” and the other “retinoic acid depletion syndrome”. A new classification will be provided for the immune system. “retinoic acid-dependent component” and “retinoic acid non-dependent component”. If this theory is verified, all the diseases where the retinoic acid metabolism is defective and retinoic acid levels are low will be identified and new approaches will be developed fortreating such diseases. When the need for retinoic acids increases, such as acute infection, high fever, severe catabolic process, or chronic antigenic stimulation, cytochrome P450 monooxidase enzymes are inhibited by drugs or internal mechanisms. Metabolism and excretion of retinoic acids stored in the liver are prevented. In this way, retinoic acid levels in the blood are raised to therapeutic levels. This is called “Endogenous Retinoic Acid Theory”. Retinoic acids also manage their metabolism through feedback mechanisms. Despite compensatory mechanisms, causes such as high fever, serious catabolic process and excessively large viral genome (SARS-CoV-2), excessive use of RIG-I and Type- I interferon synthesis pathway using retinoic acid causes emptying of retinoic acid stores. As a result, the RIG-I pathway becomes ineffective, Type-I IFN synthesis stops, and the congenital immune system collapses. Simultaneously, the immune mechanism crosses the TLR3, TLR7, TLR8, TLR9, MDA5 and UPS pathways in monocyte, macrophage, neutrophil and dendritic cells of the adaptive immune defense system that do not require retinoic acid. This leads to excessive TNFα and cytokine discharge from the pathway. With the depletion of retinoic acid stores as a result of this overuse, the immune defense mechanism switches from the congenital immune system to the adaptive immune system, where retinoic acids cannot be used. As a result of this depletion of retinoic acids, the shift of the immune system to the NFκB arm, which causes excessive cytokine release, is called “retinoic acid depletion syndrome”. COVID-19 and previously defined sepsis, SIRS and ARDS are each retinoic acid depletion syndrome. We claim that retinoic acid metabolism is impaired in autoimmune and other chronic inflammatory diseases, and therefore the RIG-I pathway and UPS degradation system are not working properly. Endogenous retinoic acid metabolism is defective in COVID-19 (cytokine storm), sepsis, SIRS, ARDS, severe viral and bacterial infectious diseases, chronic autoimmune diseases and degenerative neurological diseases. This pathogenesis explanation brings a new perspective and treatment approach to this type of disease.