Safety assessment of multiple repeated percutaneous punctures for the collection of cerebrospinal fluid in rats

The objective of this study was to examine the safety of multiple repeated percutaneous punctures of cisterna magna for collecting cerebrospinal fluid (CSF) and preliminarily determine the optimal time interval and volume at each collection. Sixty Wistar rats were randomly assigned to six groups: 10 d-0 μL, 10 d-100 μL (100 μL CSF collected at an interval of 10 days), 10 d-150 μL, 15 d-0 μL, 15 d-100 μL, and 15 d-150 μL. CSF was collected by percutaneous puncture of the cisterna magna at four time-points. Simultaneously, locomotor activity, cisterna magna pressure, and acetylcholine levels in the CSF were monitored. Compared with the 10 d-0 μL group, the escape latency by Morris water maze was significantly prolonged in the 10 d-100 μL and 10 d-150 μL groups (P<0.05). Compared with the 15 d-0 μL group, the indices of 15 d-100 μL and 15 d-150 μL groups had no significant differences. When compared with that at the first training, the exception of the 10 d-150 μL and 15 d-150 μL groups, significant differences in escape latency were found at the 6th attempt (P<0.05). Compared with baseline readings for each group, the cisterna magna pressure in the 10 d-150 μL group began to decrease significantly from the third measurement (P<0.05). The optimal time interval during four CSF collections (100 μL per collection) via cisterna magna percutaneous puncture was determined to be 15 days. The procedure did not significantly affect learning processes, performance, or other related indices.

Pioneers in the cisterna magna puncture / Pioneiros na punção da cisterna magna

Abstract At the beginning of the 20th century, cerebrospinal fluid (CSF) collection and analysis emerged as a promising aid in the diagnosis of diseases of the central nervous system. It was obtained through the established procedure of lumbar puncture, described by Heinrich Quinke in 1891. The search for an alternative way to gather the CSF emerged in animal research, highlighting the cisterna magna as a promising source, with relative safety when performed by someone trained. Described initially and in detail by James Ayer in 1920, the procedure was widely adopted by neurologists and psychiatrists at the time, featuring its multiple advantages and clinical applications. After a period of great procedure use and exponential data collection, its complications and risks relegated the puncture of the cisterna magna as an alternative route that causes fear and fascination in modern Neurology.

Resumo No início do século XX, a coleta e análise do líquido cefalorraquidiano (LCR) despontavam como um promissor auxílio no diagnóstico das doenças do sistema nervoso central. Sua obtenção se dava através do consagrado procedimento de punção lombar, descrito por Heinrich Quinke em 1891. A busca por uma via alternativa na obtenção do LCR ganhou destaque nas pesquisas animais, destacando-se na cisterna magna promissora fonte, com relativa segurança quando executada por alguém treinado. Descrito inicialmente e de maneira pormenorizada por James Ayer em 1920, o procedimento foi amplamente adotado por neurologistas e psiquiatras à época, com destaque para suas múltiplas vantagens e aplicações clínicas. Após um período de grande uso do procedimento e exponencial obtenção de dados, suas complicações e riscos relegaram a punção da cisterna magna como via alternativa que causa medo e fascínio na Neurologia moderna.

In Vivo Spinal Distribution of Cy5.5 Fluorescent Dye after Injection via the Lateral Ventricle and Cisterna Magna in Rat Model

OBJECTIVE: The purpose of this study was to find an optimal delivery route for clinical trials of intrathecal cell therapy for spinal cord injury in preclinical stage.METHODS: We compared in vivo distribution of Cy5.5 fluorescent dye in the spinal cord region at various time points utilizing in vivo optical imaging techniques, which was injected into the lateral ventricle (LV) or cisterna magna (CM) of rats.RESULTS: Although CM locates nearer to the spinal cord than the LV, significantly higher signal of Cy5.5 was detected in the thoracic and lumbar spinal cord region at all time points tested when Cy5.5 was injected into the LV. In the LV injection Cy5.5 signal in the thoracic and lumbar spinal cord was observed within 12 hours after injection, which was maintained until 72 hours after injection. In contrast, Cy5.5 signal was concentrated at the injection site in the CM injection at all time points.CONCLUSION: These data suggested that the LV might be suitable for preclinical injection route of therapeutics targeting the spinal cord to test their treatment efficacy and biosafety for spinal cord diseases in small animal models.

In Vivo Spinal Distribution of Cy5.5 Fluorescent Dye after Injection via the Lateral Ventricle and Cisterna Magna in Rat Model

OBJECTIVE: The purpose of this study was to find an optimal delivery route for clinical trials of intrathecal cell therapy for spinal cord injury in preclinical stage. METHODS: We compared in vivo distribution of Cy5.5 fluorescent dye in the spinal cord region at various time points utilizing in vivo optical imaging techniques, which was injected into the lateral ventricle (LV) or cisterna magna (CM) of rats. RESULTS: Although CM locates nearer to the spinal cord than the LV, significantly higher signal of Cy5.5 was detected in the thoracic and lumbar spinal cord region at all time points tested when Cy5.5 was injected into the LV. In the LV injection Cy5.5 signal in the thoracic and lumbar spinal cord was observed within 12 hours after injection, which was maintained until 72 hours after injection. In contrast, Cy5.5 signal was concentrated at the injection site in the CM injection at all time points. CONCLUSION: These data suggested that the LV might be suitable for preclinical injection route of therapeutics targeting the spinal cord to test their treatment efficacy and biosafety for spinal cord diseases in small animal models.

Rat Cerebrospinal Fluid Treatment Method through Cisterna Cerebellomedullaris Injection / 神经科学通报·英文版

Drugs that lack the ability to cross the blood-brain barrier (BBB) need to be placed directly into the central nervous system. Our laboratory studies the involvement of the glutamatergic system in the aggressiveness of glioma, and some ligands of glutamate receptors cannot permeate the BBB. Here, glioma-implanted rats were treated by a technique that delivers ligands directly into the cerebrospinal fluid by puncture into the cisterna cerebellomedullaris. Rats were anesthetized and fixed in a rodent stereotactic device. The head was gently tilted downwards at an angle that allowed exposure of the cisterna. Injection into the cisterna was done freehand using a gingival needle coupled to a microsyringe. The efficiency of intracisternal injection was demonstrated using a methylene blue solution. This type of injection is adaptable for any rodent model using small volumes of a variety of other drugs, and is an interesting method for neuroscience studies.

A Case of Smith-Magenis Syndrome with Multiple Organ Malformations

Smith-Magenis syndrome (SMS) is a genetic disease caused by microdeletion of p11.2 in chromosome 17. SMS patients have characteristic facial features and accompanying congenital malformations involving the brain, cardiovascular system, and urinary tract. Compared with the distinctive facial characteristics, organ malformations are less common. Several cases of SMS with tetralogy of Fallot have been reported in Korea, none of which were accompanied by other organ malformations. We present the first case report in Korea of an SMS patient with malformations of the brain, heart, and urinary tract.

Value of DWI in detection of fetus with enlargement of cisterna magna / 实用放射学杂志

Objective To detect the application value of the apparent diffusion coefficient (ADC) values using diffusion weighted imaging (DWI) in detection of fetus with enlargement of cisterna magna.Methods Sixteen fetuses with enlargement of cisterna magna (group 1) and other sixteen healthy controls (group 2) were scanned by DWI.The ADC values were measured and compared between two groups at the same regions, and between left and right brain in group 1.The correlations between ADC values,the enlarged degree of cisterna magna and gestational age were calculated respectively.Results The ADC values were lower in the white matters of bilateral frontal lobes and parietal lobes, bilateral thalami and cerebellum in group 1 than those in group 2.There were no significant differences in ADC values between left areas and right areas in group 1 (P>0.05).The ADC values in bilateral basal ganglia and thalami were negatively correlated with the gestational age (P0.05).Conclusion The ADC values were decreased in certain regions in fetuses with enlargement of cisterna magna, which suggested that ADC value might be more sensitive for detecting potential damage of brain.Combined with conventional MRI, DWI and ADC values could be regarded as accurate protocols for the detection of fetus abnormalities.

The effect of nimodipine injecting into cisterna magna on mitochondrial pathway in hippocampus of rabbit model of subarachnoid hemorrhage / 天津医药

Objective To investigate the effect of nimodipine (ND) injecting into cisterna magna on the mitochondrial pathway in hippocampus in rabbit model of subarachnoid hemorrhage (SAH). Methods Eighteen New Zealand white rabbits were randomly allocated to Sham group, SAH group and ND group, six in each group. All the animals underwent operation under anaesthesia. One mL/kg autologous non-heparinized arterial blood was injected into cisterna magna in SAH group and ND group, and the same dosage of saline was injected into cisterna magna in Sham group. Thirty minutes after injection, 1 mg/kg nimodipine was injected into cisterna magna in ND group, and equal-volume of saline was injected into cisterna magna in Sham group and SAH group. All the animals were assessed for the grade of food intake and neurological impairment, and rats were killed 72 hours after SAH. Their hippocampus were processed for detecting the expressions of Bcl-2, Bax, Caspase-3 and Cyt-C mRNA by qRT-PCR. The protein expressions of Caspase-3 and Cyt-C were detected by Western blot assay. Results Compared with the Sham group, there were lower grade of food intake, varying degrees of neurological impairment and lower ratio of Bcl-2/Bax, while the mRNA levels of Bcl-2, Bax, Caspase-3 and Cyt-C and protein levels of Caspase-3 and Cyt-C showed elevated expressions in SAH group and ND group (P0.05). There were higher ratio of Bcl-2/Bax and expression levels of Bcl-2 mRNA and lower expression levels of Bax mRNA, Caspase-3 and Cyt-C mRNA and proteins in ND group than those in SAH group (P<0.05). Conclusion Nimodipine plays a protective role in inhibiting the activity of mitochondrial pathway in hippocampus after subarachnoid hemorrhage.

Atypical Neonatal Marfan Syndrome with p.Glu1073Lys Mutation of FBN1: the First Case in Korea

Neonatal Marfan syndrome (nMFS) is considered to be on the most severe end of the spectrum of type I fibrillinopathies. The common features of nMFS include ascending aortic dilatation, severe mitral and/or tricuspid valve insufficiency, ectopia lentis, arachnodactyly, joint contractures, crumpled ear, loose skin, and pulmonary emphysema.We describe a newborn male diagnosed with nMFS. He presented several atypical features, such as diaphragmatic eventration, severe hydronephrosis with hydroureter, and dilated cisterna magna. Molecular analysis revealed a missense mutation at nucleotide 3217 (c.3217G>A) in exon 26 of the fibrillin-1 (FBN1) gene, resulting in the substitution of a glutamate for a lysine at codon 1073 (E1073K) in the 12th calcium binding epidermal growth factor-like domain of the FBN1 protein. Here we report a rare case of Nmfs with several combined atypical features, such as diaphragmatic eventration, severe hydronephrosis with hydroureter, and dilated cisterna magna. Our report is the first atypical nMFS case with p.Glu1073Lys mutation of FBN1 in Korea and may help clinicians with the diagnosis and follow-up of atypical nMFS.

Biometría del cráneo y sistema ventricular cerebral fetal: tablas de normalidad a través de pruebas no paramétricas

Objetivos: Realizar tablas de referencia a través de estadística no paramétrica para definir en percentiles los rangos de normalidad del diámetro biparietal, la circunferencia cefálica, el atrio ventricular cerebral, la cisterna magna, el cavum septum pellucidum y los ventrículos laterales, según recomendaciones de la International Society of Ultrasound in Obstetrics and Gynecology de evaluación y medida. Métodos: Estudio transversal realizado desde enero 2014 a enero 2016. Se evaluaron 1004 embarazadas normales, en diferentes edades gestacionales, y de manera previamente estandarizada se midieron las estructuras mencionadas. El análisis estadístico se realizó con el software libre PAST 3.04 para la organización de los datos de cada edad gestacional en percentiles. Se presentaron en gráficos tipo nomogramas y en modelo de regresión polinómica de primer orden. Cada gráfico fue evaluado con significancia estadística con P<0,05. Resultados: Las estructuras intracraneales pudieron medirse en su totalidad en 864 casos (86 % de los exámenes). Los diámetros biparietal y las circunferencias cefálica pudieron obtenerse en todos los casos, se observó un crecimiento directamente proporcional a la edad gestacional (P< 0,05). La medida del atrio ventricular resultó estable lo largo del embarazo. Se presentan las medidas de la cisterna magna, del cavum septum pellucidum y de los ventrículos laterales. Conclusiones: Los rangos de normalidad se representaron en tablas para correcto uso clínico y de investigación, no difieren de investigaciones previas realizadas en otros países. Se presentan valores de referencia utilizables en la consulta prenatal, a través de estadística no gaussiana.

Objectives: To carry out reference tables through non-parametric statistics to define in percentile ranges of normality of the biparietal diameter, head circumference, the cerebral ventricular atrium, the cisterna magna, cavum septum pellucidum, and the lateral ventricles, according to the recommendations of the International Society of Ultrasound in Obstetrics and Gynecology of evaluation and measurement. Methods: A cross-sectional study was carried out from January 2014 to January 2016; 1004 normal pregnant women, in different gestational ages, were evaluated, and the mentioned structures, previously standardized, were measured. The statistical analysis was performed with the FOSS PAST 3.04 for the organization of the data at each gestational age, in percentiles. They arose in graphic type nomograms and first-order polynomial regression model. Each graphic was evaluated with statistics significance with P < 0.05. Results: The intracranial structures could be measured entirely in 864 cases (86% of the tests). Biparietal diameter and head circumferences were obtained in all cases; it was observed a directly proportional growth to gestational age (P < 0.05). The measurement of the ventricular Atrium was stable throughout the pregnancy. Measures of the cisterna magna, cavum septum pellucidum and of the lateral ventricles are represented. Conclusions: Normal ranges are represented in tables for correct clinical use and research, the results are not different from previous research conducted in other countries. Usable reference values, in the prenatal consultation, through non-Gaussian statistics are presented.

Dandy Walker: reporte de un caso / Dandy Walker: case report

Introducción: la malformación de Dandy­Walker es una alteración congénita que compromete el cerebelo y el cuarto ventrículo. Esta condición se caracteriza por agenesia o hipoplasia del vermis cerebeloso, dilatación quística del cuarto ventrículo y alargamiento de la fosa posterior. Aproximadamente el 80% de los pacientes presenta hidrocefalia. La triada característica de la malformación de Dandy-Walker que consiste: agenesia parcial o completa del vermis, dilatación quística del cuarto ventrículo y alargamiento de la fosa posterior. El diagnóstico prenatal es preferible realizarlo luego de las 18 semanas, el postnatal se hace con ultrasonido transfontanelar, resonancia magnética y tomografía axial computarizada. El tratamiento de esta patología está basado en el manejo de la hidrocefalia. 1 Caso: a continuación presentamos un caso clínico de Dandy Walker de la Unidad de Medicina Materno Fetal del Hospital Carlos Andrade Marín de Quito.

Introduction: Dandy-Walker malformation is a rare congenital disease involving the cerebellum and the fourth ventricle. This condition is characterized by agenesia or hypoplasia of the cerebellar vermis, cystic dilatation of the fourth ventricle, and enlargement of the posterior fossa. Approximately 80% of patients have hydrocephalus. Dandy-Walker malformation was described by Dandy and Blackfan in 1914. The characteristic triad of Dandy-Walker malformation is consisting of complete or partial agenesis of the vermis, cystic dilatation of the fourth ventricle and an enlarged posterior fossa. The prenatal diagnosis of Dandy-Walker malformation is better after 18 weeks of gestation. After birth it is best diagnosed with the help of transfontanelar ultrasound, magnetic resonance imaging, and computerized axial tomography. The treatment for this condition is based in the management of hydrocephalus. 1 Case: below is a case report of Dandy Walker at the Maternal Fetal Medical Unit of the Carlos Andrade Marin Hospital in Quito.

Protective effect of naloxone injected into cisterna magna on brain tissues of rats following cardiopulmonary resuscitation / 第二军医大学学报

Objective To investigate the effects of naloxone injected into cisterna magna on S100β protein and neuron-specific enolase (NSE) levels in serum and the histopathology of brain tissue of rats following cardiopulmonary resuscitation(CPR). Methods Thirty adult male SD rats were randomly divided into 3 groups: Sham group, Conventional CPR group (intravenous injection of epinephrine, 0.2 mg/kg) and Naloxone CPR group(cisterna magna injection of naloxone, 2 mg/kg). Asphyxiation was used to set up rat cardiac arrest model, and corresponding drugs were given when the resuscitation was carried out. The blood samples were taken from orbital venous plexus at 0.5 h, 3 h, 6 h and 24 h after restoration of spontaneous circulation (ROSC). Enzyme-linked immunosorbent assay (ELISA) was used to detect serum levels of S100β protein and NSE. Brain tissue was taken after the last blood sampling and the pathology of brain was observed by hematoxylin-eosin (H-E) staining. Results Serum S100β protein levels of the Conventional CPR group and Naloxone CPR group were significantly higher than those of the Sham group at all time points (P <0.01); compared with the Conventional CPR group, S100β protein levels in Naloxone CPR group were significantly decreased at 3 h, 6 h, and 24 h after ROSC (P <0.05 or P <0.01). Serum NSE protein level of the Conventional CPR group at all time points and Naloxone CPR group at 6 h and 24 h after ROSC were significantly higher than those of the Sham group (P <0.05 or P <0.01). Serum NSE protein levels were significantly decreased at 6 h and 24 h after ROSC in Naloxone CPR group compared with the Conventional CPR group (P <0.05 or P <0.01). Moreover, hippocampus glial cells of Conventional CPR group were scattered and decreased, with condensed eosinophilic cytoplasm, narrowed nuclues, unclear nucleolus, and swollen and deformed capillaries. However, most nerve cells of Naloxone CPR group had rich cytoplasm and the nucleolus was clear; only a few nerve cells and capillaries showed edema-like changes of different degrees. Conclusion Naloxone injected into cisterna magna has a prominent protective effect on the brain of rats following cardiopulmonary resuscitation.

Fetal brainstem-vermis angle and brainstem-tentorium angle measured with three-dimensional ultrasonography and its application in mega cisterna magna / 中华超声影像学杂志

Objective To establish the ranges of normal reference values of fetal brainstem-vermis angle (BVA)and brainstem-tentorium angle (BTA)in normal fetuses at different gestational weeks,and to evaluate their clinical values in the diagnosis of mega cisterna magna.Methods Totally 320 normal singleton fetuses between 1 8 and 40 weeks of gestation were enrolled in this study.Three-dimensional ultrasound (3DUS)with volume contrast imaging (VCI)was used to measure their BVA and BTA,the correlations of BVA and BTA with gestational age were analyzed.The BVA and BTA of 24 fetuses with mega cisterna magna were also measured and were compared with those of the normal fetuses.Results In these normal fetuses,the BVA and BTA showed no correlations with gestational age (r=-0.05,0.04,both P >0.05);the ranges of normal reference values of BVA and BTA were 2.23°-19.30°and 18.53°-48.13°, respectively.The BVA and BTA of 24 fetuses with mega cisterna magna were 4.23°-17.42°and 20.41°-40.89°,respectively,which were not significantly different from those of normal fetuses (t =-0.55,0.92, both P >0.05).Conclusions 3DUS with VCI is feasible for measuring the BVA and BTA of fetuses,and the measured values can be used as the reference standards for BVA and BTA measurement in China.

Intervalos de referência para o volume da cisterna magna fetal por meio do método bidimensional usando o modo multiplanar da ultrassonografia tridimensional / Reference intervals of fetal cisterna magna volume by two-dimensional method using the multiplanar mode of three-dimensional ultrasonography

Objetivo: Determinar intervalos de referência para o volume da cisterna magna fetal por meio do método bidimensional (2D) usando o modo multiplanar da ultrassonografia tridimensional. Materiais e Métodos: Estudo de corte transversal com 224 gestantes normais entre a 17ª e 29ª semanas. O volume foi obtido automaticamente pela multiplicação dos três maiores eixos nos planos axial e sagital pela constante 0,52. Regressão polinomial foi realizada para obter correlação entre o volume 2D da cisterna magna e a idade gestacional, sendo os ajustes realizados pelo coeficiente de determinação (R2). Confiabilidade e concordância foram obtidas pelo coeficiente de correlação intraclasse (CCI) e limites de concordância. Resultados: A média do volume da cisterna magna 2D variou de 0,71 ± 0,19 cm3 para 4,18 ± 0,75 cm3 entre a 17ª e 29ª semanas, respectivamente. Observou-se boa correlação do volume da cisterna magna fetal 2D e a idade gestacional (R2 = 0,67). Observou-se excelente confiabilidade e concordância intraobservador com CCI = 0,89 e limites de concordância 95% (-52,0; 51,8), respectivamente. Observou-se baixa confiabilidade e concordância interobservador com CCI = 0,64 e limites de concordância 95% (-110,1; 84,6), respectivamente. Conclusão: Intervalos de referência para o volume 2D da cisterna magna fetal usando o modo multiplanar da ultrassonografia tridimensional foram determinados e apresentaram excelente confiabilidade e concordância intraobservador. .

Objective: To establish reference intervals for the fetal cisterna magna volume by means of two-dimensional (2D) method using the multiplanar mode of three-dimensional ultrasonography. Materials and Methods: Cross-sectional study with 224 healthy pregnant women between the 17th and 29th gestational weeks. The volume was automatically obtained by multiplying the three major axes in axial and sagittal planes by the constant 0.52. Polynomial regression was utilized to establish the correlation between fetal cisterna magna volume and gestational age, with adjustments by coefficient of determination (R2). Reliability and agreement were obtained by intraclass correlation coefficient (ICC) and limits of agreement, respectively. Results: Mean fetal cisterna volume with the 2D method ranged from 0.71 ± 0.19 cm3 to 4.18 ± 0.75 cm3 at the 17th and 29th weeks, respectively. The authors observed a good correlation between fetal cisterna magna volume and gestational age (R2 = 0.67), excellent intraobserver reliability and agreement with ICC = 0.89 and limits of agreement 95% (-52.0; 51.8), respectively, and low interobserver reliability and agreement with ICC = 0.64 and limits of agreement 95% (-110.1; 84.6), respectively. Conclusion: Reference intervals for fetal cisterna magna volume by means of 2D method using the multiplanar mode of three-dimensional ultrasonography were established and presented excellent intraobserver reliability and agreement. .

Fetal cisterna magna septa: sonographic feature and its clinical significance / 中华超声影像学杂志

Objective To establish normative data for the fetal cisterna magna septa (CMS) at various gestational age,and to evaluate its clinical significance.Methods A total of consecutive fetal between 14 and 40 gestational week(GW) were included in this prospective study.The length and width of CMS were measured by two-dimensional ultrasonography.Regression analysis was used to study the relationship between the width and length of the fetal cisterna magna septa and gestational age.Twenty-five case of fetuses with the absence of CMS and 12 case of fetuses with the enlargement of CMS were retrospectively analyzed in the past six years in our hospital.Results ①The fetal CMS length and width increased gradually between 14 and 22 GW,then plateaued between 23 GW and 36 GW,and decreased after 37 GW.This ultrasonographic pattern was in agreement with normal development of rhombencephalon.②The absence of CMS in the fetuses were common in Dandy-Walker syndrome,holoprosencephaly,severe hydrocephalus,neural tube defects,rhombencephalon synapsis and Arnold-Chiari malformation.The enlargement of CMS in the fetuses may be shown in physiologic enlargement of posterior fossa.ConclusionsCMS is a potential new marker for normal development of rhombencephalon.The enlargement and absence of CMS are related to various malformations of central neural system,especially in the abnormalities of posterior fossa.

Manic Episode Associated with Mega Cisterna Magna

Mega cisterna magna is a part of "Dandy-Walker Complex" and it is characterized by the enlargement of the cisterna magna, morphologically intact vermis and cerebellar hemispheres. We report a case of manic attack in a 23-year-old man with mega cisterna magna. The patient was treated with quetiapine 1,000 mg/day and sodium valproate 1,500 mg/day and the symptoms were ameliorated within 2.5 months. In this case, mega cisterna magna and manic symptoms may be found together coincidentally or any cerebellar dysfunction due to mega cisterna magna may cause or contribute to the appearance of affective symptoms. To our knowledge, this is the first case reporting manic attack with psychotic symptoms associated with mega cisterna magna. This report suggests that any lesion in the cerebellum might contribute to the occurrences of some affective and psychotic symptoms seen in bipolar disorder.

Malformación de Dandy-Walker: reporte de un caso / Dandy-Walker malformation: a case report

La malformación de Dandy–Walker es una alteración congénita que compromete el cerebelo y el cuarto ventrículo. Esta condición se caracteriza por agenesia o hipoplasia del vermis cerebeloso, dilatación quística del cuarto ventrículo y alargamientode la fosa posterior. Aproximadamente, 70-90% de los pacientes presenta hidrocefalia, que se desarrolla, generalmente, en el periodo postnatal. La malformación de Dandy-Walker puede estar asociada con atresia del foramen de Magendie y, posiblemente, del foramen de Luschka. La malformación de Dandy-Walker fue descrita por primera vez por Dandy y Blackfan en 1914. Estudios realizados por D’Agostino en 1963 y Hart et al en 1972 definieron la triada característica de la malformación de Dandy-Walker que consiste en (1) agenesia parcial o completa del vermis; (2) dilatación quística del cuarto ventrículo y (3) alargamiento de la fosa posterior.Esta triada típica se encuentra, generalmente, relacionada con hidrocefalia supratentorial, que debe considerarse más como una complicación que como parte del complejo de la malformación. La incidencia de la malformación de Dandy-Walker es de 1 caso/25 000 – 35 000 nacidos vivos. La malformación de Dandy- Walker es la causa de aproximadamente 1-4% de los casos de hidrocefalia; las tasas de mortalidad por la malformación alcanzan entre un 12-50%; y, asociada con otras malformaciones congénitas, constituye el 83% de la mortalidad postnatal.La malformación de Dandy-Walker ocurre más frecuentemente en mujeres que en hombres; el diagnóstico se hace con ultrasonido, resonancia magnética y Tomografía axial computarizada. El tratamiento de esta patología está basado en el manejo de la hidrocefalia.

Dandy-Walker malformation is a rare congenital disease involving the cerebellum and the fourth ventricle. This condition is characterized by agenesia or hypoplasia of the cerebellar vermis, cystic dilatation of the fourth ventricle, and enlargement of the posterior fossa. Approximately 70-90% of patients have hydrocephalus, which often develops postnatally. Dandy-Walker malformation may also be associated to atresia of Magendie’s foramen and, possibly, Luschka’s foramen.Dandy-Walker malformation was described by Dandy and Blackfan in 1914. Then, studies by D’Agostino in 1963 and Hart et al in 1972 defined the characteristic triad of Dandy-Walker malformation as consisting of (1) complete or partial agenesis of thevermis, (2) cystic dilatation of the fourth ventricle and, (3) an enlarged posterior fossa. This triad is typically found in association with supratentorial hydrocephalus, which should be considered a complication rather than part of the malformation complex. The incidence of Dandy-Walker malformation is 1 case/25 000-35 000 live births. Dandy-Walker malformation accounts for approximately 1-4% of hydrocephalus cases. Overall mortality rates of 12-50%, associated congenital anomalies contributed to 83% of postnatal deaths. Dandy-Walker malformation occurs more frequently in females than in males. Dandy-Walkermalformation is best diagnosed with the help of ultrasound, magnetic resonance imaging, and computerized axial tomography. The treatment for this condition is based in the management of hydrocephalus.

Malformación de Dandy-Walker en el adulto / Dandy-Walker malformation in on adult

Esta patologia es una rara malformación cerebral congénita de fosa posterior. Los pacientes que la padecen, presentan retraso en el desarollo, agrandamiento de circunferencia de cabeza con síntomas y signos de hidrocefalia. La triada característica es: ausencia o hipoplasia del vermis de cerewbelo, agrandamiento de fosa posterior con elevación de senos transversos y dilatación del cuarto ventrículo. La hidrocefalia está considerada como complicación de esta compleja malformación. Casi siempre se observa en el período perinatal o en la infancia temprana. Reportamos el caso de presentación infrecuente en paciente de 51 años, y hacemos aproximación de características clínicas, evaluaciones y hallazgos patológicos de proceso

Impacted cisterna magna without syringomyelia associated with lancinating headache, throbbed nuchal pain and paraparesis treated byposterior fossa decompression

A 29-year-old woman with acute lancinating headache, throbbed nuchal pain and subacute paraparesis underwent brain MRI in supine position that depicted: the absence of the cisterna magna, filled by non herniated cerebellar tonsils and compression of the brain stem and cisternae of the posterior fossa, which are aspects of the impacted cisterna magna without syringomyelia and without hydrocephalus. During eight days, pain was constant and resistant to drug treatment. Osteodural-neural decompression of the posterior fossa, performed with the patient in sitting position, revealed: compression of the brainstem, fourth ventricle and foramen of Magendie by herniated cerebellar tonsils, which were aspirated. Immediately after surgery, the headache and nuchal pain remmited. MRI depicted the large created cisterna magna and also that the cerebellar tonsils did not compress the fourth ventricle, the foramen of Magendie and the brainstem, besides the enlargement of posterior fossa cisternae. Four months after surgery, headache, nuchal pain and paraparesis had disappeared but hyperactive patellar and Achilles reflexes remained.

Uma paciente de 29 anos de idade com quadro agudo de cefaléia lancinante, dor terebrante na nuca e paraparesia subaguda foi submetida a RM do encéfalo, em posição supina, que revelou: ausência da cisterna magna, preenchida por tonsilas cerebelares não herniadas e compressão do tronco encefálico e das cisternas da fossa posterior, compatíveis com o diagnóstico de cisterna magna impactada sem siringomielia e sem hidrocefalia. Por oito dias a dor foi constante e resistente aos analgésicos. Com a paciente em posição sentada, foi realizada descompressão osteodural-neural da fossa posterior associada a aspiração das tonsilas cerebelares. Os achados perioperatórios foram caracterizados por herniação das tonsilas cerebelares que comprimiam o tronco cerebral, o quarto ventrículo e o forame de Magendie. No pós-operatório imediato houve remissão da cefaléia e da dor na nuca. A RM evidenciou a cisterna magna recém-criada, alargamento do quarto ventrículo e das cisternas do tronco encefálico. Quatro meses depois, a paciente continuava sem cefaléia, sem dor na nuca e sem paraparesia. Entretanto, permaneceu a hiperatividade dos reflexos patelares e aquileus.

Hemorrhage in the Cisterna Magna after Acupuncture

Acupuncture is one of the most popular complimentary therapies these days not only in Asia, but also in USA and Europe. Acupuncture is generally regarded as a safe procedure in the general public. However, acupuncture is not free of risk; complications of acupuncture have been repeatedly reported in the medical literatures. The authors report a rare case of hemorrhage in the cisterna magna after acupuncture. Acute frontal headache, dizziness, neck pain, neck stiffness, and paresthesia or tingling discomfort at arms and legs developed immediately after an acupuncture treatment that had been performed to treat her chronic posterior neck pain. Computerized tomography scans and magnetic resonance images(MRI) showed a 1.2x0.8cm-sized high density and high signal mass within the cisterna magna. It is probable that the acupuncture needle had been inserted deep enough to enter the cisterna magna and provoked a small hemorrhage in the cistern. She gradually recovered from the symptoms. Physicians and acupuncture therapists should be aware of the adverse events associated with acupuncture.