Development of an experimental model of neurocysticercosis-induced hydrocephalus. Pilot study

ABSTRACT PURPOSE: To develop an experimental model of neurocysticercosis-induced hydrocephalus METHODS: There were used 17 rats. Ten animals were inoculated with Taenia crassiceps cysts into the subarachnoid. Five animals were injected with 0.1ml of 25% kaolin (a standard solution for the development of experimental hydrocephalus) and two animals were injected with saline. Magnetic resonance imaging (MRI) was used to evaluate enlargement of the ventricles after one or three months of inoculation. Volumetric study was used to quantify the ventricle enlargement. RESULTS: Seven of the 10 animals in the cyst group developed hydrocephalus, two of them within one month and five within three months after inoculation. Three of the five animals in the kaolin group had hydrocephalus and none in the saline group. Ventricle volumes were significantly higher in the 3-months MRI cyst subgroup than in the 1-month cyst subgroup. Differences between cyst subgroups and kaolin group did not reach statistical significance. CONCLUSION: The developed model may reproduce the human condition of neurocysticercosis-related hydrocephalus, which exhibits a slowly progressive chronic course.

Sporadic lateral ventricular hemangioblastoma presenting with Intraventricular and Subarachnoid Haemorrhage

Intraventricular hemangioblastoma [HB] is very rare; few cases of intraventricular HB have been reported in the literature, either sporadically or in association with von Hippel-Lindau disease. Furthermore, the incidence of ventricular haemorrhage from HB seems to be uncommon. We report a unique case of sporadic HB of the right lateral ventricle presenting with intratumoural and intraventricular haemorrhage in addition to multifocal intracranial superficial siderosis, indicating the presence of a subarachnoid haemorrhage [SAH] as well. Such a combination has not been reported before. In the future, the detection of an intraventricular mass in association with ventricular haemorrhage, with or without SAH, should include HB as a differential diagnosis, particularly when the imaging appearances are not typical of the more common intraventricular tumours

Colpocephaly, a wide clinical spectrum for one cephalic disorder: three new cases from Kuwait

Colpocephaly is an abnormal enlargement of the occipital horns of both lateral ventricles; it is also described as persistence of the fetal configuration of the lateral ventricles. Since it was first described, Colpocephaly has been found in association with several abnormalities of the brain. The spectrum of clinical presentation is wide, including mainly various degrees of mental retardation, seizures, and motor and visual abnormalities. Approximately 50 cases have been described in children. Herein we report three new cases of Colpocephaly. One of the cases was associated with CHARGE syndrome. To the best of our knowledge, this is the first publication to report such an association

0.1T magnetic resonance image in the study of experimental hydrocephalus in rats. Accuracy of the method in the measurements of the ventricular size / Imagem de ressonância magnética de 1,0T no estudo da hidrocefalia experimental em ratos. Avaliação do método de medição do tamanho ventricular

PURPOSE: To investigate the accuracy of 1.0T Magnetic Resonance Imaging (MRI) to measure the ventricular size in experimental hydrocephalus in pup rats. METHODS: Wistar rats were subjected to hydrocephalus by intracisternal injection of 20% kaolin (n=13). Ten rats remained uninjected to be used as controls. At the endpoint of experiment animals were submitted to MRI of brain and killed. The ventricular size was assessed using three measures: ventricular ratio (VR), the cortical thickness (Cx) and the ventricles area (VA), performed on photographs of anatomical sections and MRI. RESULTS: The images obtained through MR present enough quality to show the lateral ventricular cavities but not to demonstrate the difference between the cortex and the white matter, as well as the details of the deep structures of the brain. There were no statistically differences between the measures on anatomical sections and MRI of VR and Cx (p=0.9946 and p=0.5992, respectively). There was difference between VA measured on anatomical sections and MRI (p<0.0001). CONCLUSION: The parameters obtained through 1.0T MRI were sufficient in quality to individualize the ventricular cavities and the cerebral cortex, and to calculate the ventricular ratio in hydrocephalus rats when compared to their respective anatomic slice.

OBJETIVO: Investigar a fidelidade das Imagens de Ressonância Magnética de 1,0T no estudo do tamanho ventricular na hidrocefalia experimental em ratos jovens. MÉTODOS: Ratos Wistar foram submetidos à hidrocefalia através da injeção intracisternal de caulim 20%. Dez animais permaneceram sem injeção para uso como controles. Ao final do experimento, os animais foram submetidos à Ressonância magnética de encéfalo e sacrificados. O tamanho ventricular foi avaliado por três medidas: razão ventricular (VR), espessura cortical (Cx) e área ventricular (VA), tomadas em fotografias das secções anatômicas e nas imagens de ressonância magnética (RM). RESULTADOS: As imagens por RM apresentaram qualidade suficiente para individualizar os ventriculos laterais, mas a distinção entre córtex e substância branca, bem como detalhamento das estruturas profundas do encéfalo não foram possíveis. Quando comparadas as medidas em seções anatômicas e RM, não houve diferença estatística entre as médias de razão ventricular e espessura cortical (p=0,9946 e p=0,5992, respectivamente). Houve diferença da área ventricular comparando-se as secções anatômicas e ressonância magnética (p<0,0001). CONCLUSÃO: Os parâmetros obtidos através de imagens da ressonância magnética de 1,0T foram suficientes para individualizar as cavidades ventriculares e o córtex cerebral, e para calcular o tamanho ventricular em ratos hidrocefálicos quando comparados aos seus respectivos cortes anatômicos.

A cell junction pathology of neural stem cells leads to abnormal neurogenesis and hydrocephalus

Most cells of the developing mammalian brain derive from the ventricular (VZ) and the subventricular (SVZ) zones. The VZ is formed by the multipotent radial glia/neural stem cells (NSCs) while the SVZ harbors the rapidly proliferative neural precursor cells (NPCs). Evidence from human and animal models indicates that the common history of hydrocephalus and brain maldevelopment starts early in embryonic life with disruption of the VZ and SVZ. We propose that a "cell junction pathology" involving adherent and gap junctions is a final common outcome of a wide range of gene mutations resulting in proteins abnormally expressed by the VZ cells undergoing disruption. Disruption of the VZ during fetal development implies the loss of NSCs whereas VZ disruption during the perinatal period implies the loss of ependyma. The process of disruption occurs in specific regions of the ventricular system and at specific stages of brain development. This explains why only certain brain structures have an abnormal development, which in turn results in a specific neurological impairment of the newborn. Disruption of the VZ of the Sylvian aqueduct (SA) leads to aqueductal stenosis and hydrocephalus, while disruption of the VZ of telencephalon impairs neurogenesis. We are currently investigating whether grafting of NSCs/neurospheres from normal rats into the CSF of hydrocephalic mutants helps to diminish/repair the outcomes of VZ disruption.

Changes caused by hidrocephalus, induced by kaolin, in the corpus callosum of adult dogs / Alterações causadas pela hidrocefalia, induzida por caulim, no corpo caloso de cães adultos

PURPOSE: To analyze the ventricular enlargement and myelination of the corpus callosum in adult dogs after four and eight weeks of kaolin-induction of hydrocephalus. METHODS: 36 dogs were randomly divided into 3 groups: 1 - without hydrocephalus, 2 - kaolin-induction of hydrocephalus until the fourth week, and 3 - kaolin-induction of hydrocephalus until the eighth week. Ventricular ratios and volumes were calculated using magnetic resonance images, and myelination of the corpus callosum were histologically evaluated using solocromo-cianin stain. RESULTS: Radiological hydrocephalus was observed in 93.75 percent and overall mortality was 38.4 percent. Ventricular volumes and ratios were higher in groups 2 and 3 compared to group 1 and similar when measures in the fourth and eighth weeks were compared in the group 3. Indices of luminescence in the knee and in the splenium of the corpus callosum were higher in group 2 than in group 1 indicating that there was loss of myelin in group 2, and similar in groups 1 and 3, showing a tendency to remyelination after 8 weeks. CONCLUSION: The corpus callosum of dogs with kaolin-induced hydrocephalus responds with demyelination of the knee and splenium by the fourth week with a tendency to remyelination by the eighth week.

OBJETIVO: Analisar a dilatação ventricular e a mielinização do corpo caloso em cães adultos após quatro e oito semanas da indução de hidrocefalia por caulin. MÉTODOS: 36 cães foram aleatoriamente divididos em 3 grupos: 1- sem hidrocefalia, 2- quatro semanas de hidrocefalia induzida por caulin, 3- oito semanas de hidrocefalia induzida por caulin. As razões e volumes ventriculares foram calculados utilizando imagens de ressonância magnética, e, a mielinização do corpo caloso por estudo histológico (coloração com solocromo- cianina). RESULTADOS: Hidrocefalia foi observada radiologicamente em 93,75 por cento e a mortalidade global foi de 38,4 por cento. Os volumes e as razões ventriculares foram maiores nos grupos 2 e 3 em relação ao grupo 1 e semelhantes nas quarta e oitava semanas no grupo 3. Índices de luminescência no joelho e no esplênio do corpo caloso foram maiores no grupo 2 em relação ao grupo 1, indicando que houve perda de mielina no grupo 2, e semelhantes nos grupos 1 e 3, mostrando uma tendência à remielinização em torno de 8 semanas. CONCLUSÃO: O corpo caloso de cães com hidrocefalia induzida por caulin responde com desmielinização no joelho e esplênio em torno de quatro semanas com tendência à remielinização em torno da oitava semana.

Complejo nódulo subependimario-astrocitoma subependimario gigantocelular en niños con esclerosis tuberosa / Subependymal nodules-subependymal giant cell astrocytoma complex in children with tuberous sclerosis

El objetivo fue describir las características clínico imagenológicas de niños con esclerosis tuberosa que presentaron el complejo Nódulo Subependimario (NS)-Astrocitoma Subependimario Gigantocelular(ASGC) y analizar el comportamiento evolutivo de dicho "complejo" para detectar precozmente su crecimiento y evitar las complicaciones de la hipertensión endocraneana (HTE). Evaluamos 22 pacientes con diagnóstico anátomo patológico de ASGC. El diagnóstico del tumor se realizó a una media de 10.1 años. Pudimos observar la evolución de NS a ASGC; estos NS se ubicaron adyacentes al agujero de Monro y con el tiempo tuvieron un importante crecimiento con intensa captación de contraste e hidrocefalia. La aceleración en el crecimiento de estos NS y su "transformación" en ASGC se produjo a los 10 años de edad promedio, con un diámetro medio de 9 mm. Ningún NS alejado de los forámenes de Monro evolucionó a ASGC. Quince pacientes (68%) fueron operados con síntomas de hipertensión endocraneana. La edad media de la cirugía fue 10.8 años. Seis pacientes presentaron déficit visual. En estos últimos, el diámetro medio mayor del tumor fue 31.5 mm, mayor que los 18.7 mm del grupo de pacientes que no presentó secuela visual. El seguimiento clínico imagenológico periódico de toda lesión subependimaria próxima a los agujeros de Monro, permitiría en etapa presintomática anticipar un tratamiento quirúrgico, que reduciría la incidencia de HTE. Estudios prospectivos podrían determinar si el complejo NS-ASGC corresponde a una misma entidad en distinta etapa evolutiva, o son dos lesiones con diferente potencial de crecimiento.

The object of this paper is to describe the imaging and clinical characteristics of subependymal nodule (SN) - subependymal giant cell astrocytoma (SGCA) complex in tuberous sclerosis and analyze its evolution in order to attempt early detection and the prevention of intracranial hypertension. We evaluated 22 patients with the pathological diagnosis of SGCA. The diagnosis was made at a median of 10.1 years old. We were able to observe the evolution of SN to ASGC: these SN were localized adjacent to the foramen of Monro and with time they underwent an important development with intense contrast enhancement and hydrocephalus. The acceleration in SN growth and its "transformation" into SGCA occurred at an average of 10 years of age, with a mean diameter of 9 mm. No SN located far from the foramen of Monro evolutioned to SGCA. Fifteen patients (68%) were operated with symptoms of intracranial hypertension. Average age at surgery was 10.8 years old. Six patients presented visual deficit and in these, the average diameter of the tumor was 31.5 mm, a high value when compared to 18.7 mm in the patients without visual deficit. The imaging and clinical follow-up of any subependymal lesion close to the foramen of Monro will permit, at a presymptomatic stage, an anticipation of surgical treatment thus reducing intracranial hypertension incidence. Prospective studies could determine whether the SN-SGCA complex corresponds to the same entity in distinct evolution stages or to two lesions with different growth potential.

Erythropoietin Attenuates Brain Injury, Subventricular Zone Expansion, and Sensorimotor Deficits in Hypoxic-Ischemic Neonatal Rats

The aim of this study was to investigate the effect of erythropoietin (EPO) on histological brain injury, subventricular zone (SVZ) expansion, and sensorimotor function deficits induced by hypoxia-ischemia (HI) in newborn rat pups. Seven-day-old male rat pups were divided into six groups: normoxia control, normoxia EPO, hypoxia control, hypoxia EPO, HI control, and HI EPO group. Sham surgery or HI was performed in all animals. HI was induced by ligation of the right common carotid artery followed by 90 min of hypoxia with 8% oxygen. Recombinant human EPO 3 U/g or saline was administered intraperitoneally, immediately, at 24- and 48-hr after insult. At two weeks after insult, animals were challenged with cylinder-rearing test for evaluating forelimb asymmetry to determine sensorimotor function. All animals were then sacrificed for volumetric analysis of the cerebral hemispheres and the SVZ. The saline-treated HI rats showed marked asymmetry by preferential use of the non-impaired, ipsilateral paw in the cylinder-rearing test. Volumetric analysis of brains revealed significantly decreased preserved ipsilateral hemispheric volume and increased ipsilateral SVZ volume compared with the sham-operated animals. Treatment of EPO significantly improved forelimb asymmetry and preserved ipsilateral hemispheric volume along with decreased expansion of ipsilateral SVZ following HI compared to the saline-treated HI rats. These results support the use of EPO as a candidate drug for treatment of neonatal hypoxic-ischemic brain damage.

Astrocitoma subependimário de células gigantes em pacientes com esclerose tuberosa: achados em ressonância magnética de dez casos / Subependymal giant cell astrocytoma in patients with tuberous sclerosis: magnetic resonance imaging findings in ten cases

OBJETIVO: Relatar os achados de ressonância magnética (RM) em 10 casos de astrocitoma subependimário de células gigantes (ASCG) em pacientes com esclerose tuberosa (ET). MÉTODO: Foram estudados de forma retrospectiva 10 pacientes com ET e diagnóstico histológico comprovado de ASCG. Quatro pacientes eram do sexo masculino e seis do feminino, com idade média de 15,7 anos. Todos os pacientes foram investigados com RM, sendo os exames revisados por dois radiologistas, havendo decisão por consenso sobre os achados de imagem. Foram analisados os seguintes achados: localização, dimensões, intensidade de sinal em T1/T2, realce pós-contraste e outros achados associados. RESULTADOS: Todos os pacientes apresentaram lesão única sugestiva de ASCG, medindo entre 1,5 cm e 8 cm em seu maior diâmetro. Oito lesões foram encontradas junto ao forame de Monro (80 por cento) e duas adjacentes ao corpo do ventrículo lateral (20 por cento). Os tumores apresentavam nas imagens pesadas em T1 médio sinal (70 por cento) e em T2 alto sinal (100 por cento), com realce intenso após a administração do gadolínio (100 por cento). CONCLUSÃO: Os astrocitomas subependimários de células gigantes em pacientes com ET em geral apresentam-se como lesão única próxima ao forame de Monro, com médio sinal nas imagens ponderadas em T1, alto sinal em T2 e realce intenso após a administração de contraste.

OBJECTIVE: To report the magnetic resonance imaging (MRI) findings in 10 patients with subependimal giant cell astrocytoma (SGCA) and tuberous sclerosis (TS). METHOD: Ten patients were retrospectively studied, presenting TS and histologically proven SGCA. Four patients were male and six female, with mean age 15.7 years. All patients underwent MRI, which was analyzed by two radiologists, final diagnosis was reached by consensus. The following findings were studied: topography, size, signal intensity on T1/T2-weighted images, contrast enhancement and associated findings. RESULTS: All patients presented a single lesion suggestive of SGCA, measuring between 1.5 cm and e 8 cm in the largest diameter. Eight lesions were found near the foramen of Monro and two in the body of the lateral ventricles. The tumors showed preferentially intermediate signal on T1 (70 percent), high signal on T2-weighted images (100 percent), with intense enhancement after contrast administration (100 percent). CONCLUSION: SGCA in patients with TS usually presents as a single lesion near the foramen of Monro, with intermediate signal on T1, high signal on T2-weighted images and intense contrast enhancement.

Risk factors for intraventricular hemorrhage in very low birth weight infants

The purpose of this study was to determine the risk factors which predispose to the development of high grade IVH [grade 3 and 4] in very low birth weight infants. In a retrospective case control clinical study files of all premature infants with birth weights less than 1500 grams admitted between April 2004 and Oct 2005 to the neonatal intensive care unit of Akbar Abadi hospital in Tehran were reviewed. 39 infants with IVH grade 3 and 4 were identified. A control group of 82 VLBW infants matched for gestational age and birth weight were selected. Prenatal data, delivery characteristics, neonatal course data and reports of cranial ultrasonography were carefully collected for both groups. Those variables that achieved significance [p<0.05] in univariate analysis entered to multivariate logistic regression analysis. A total of 325 VLBW infants were evaluated. Mortality rate was 21.5%. Of the remaining the incidence of high grade IVH was 15.5%. Multivariate logistic analysis showed that following factors are associated with greater risk of high grade IVH occurrence: Low gestational age [OR: 3.72; 95% CI: 1.65-8.38], low birth weight [OR: 3.42; 95% CI: 1.65-8.38], low Apgar score at 5 minute [OR:1.58; 95% CI:1.59-6.32], hyaline membrane disease [HMD, OR: 3.16; 95% CI: 1.42-7.45] and maternal tocolytic therapy with magnesium sulfate [OR: 4.40; 95% CI: 1.10-24.5]. Our results showed that maternal tocolytic therapy, mechanical ventilation, low gestational age, low birth weight, apnea, and low 5 minute Apgar score increased the risk of major IVH

Neumoencéfalo, otitis media y meningitis a neumococo / Pneumocephalus, middle otitis and meningococcic meningitis

La meningitis bacteriana es una enfermedad con alta morbi-mortalidad, el germen prevalente es el Strep pneumoniae y constituye la complicación intracraneal más frecuente de la otitis media aguda en el adulto. La TAC de cerebro es de indicación habitual ante su sospecha, previa a la realización de la punción lumbar, y en el 13 por ciento de los casos, los hallazgos son compatibles con una disrupción de la barrera dural, de la que el neumoencéfaloi (NE) es una de las consecuencias. Se presenta un paciente con meningitis bacteriana aguda por neumococo, otitis media y NE, sin traumatismo, malformación, tumor o cirugía previa

Dilatación del cavum Vergae en el feto: dos casos clínicos y revisión de la literatura / Dilated cavum Vergae in the fetus: two clinical cases and literature review

Comunicamos el diagnóstico prenatal de dos casos de dilatación del cavum Vergae. También revisamos la literatura acerca de lesiones anecogénicas intracerebrales supratentoriales interhemisféricas, con el propósito de establecer criterios de diagnóstico diferencial antenatal y determinar su pronóstico.

Esquizencefalia: diagnóstico prenatal por medio de ultrasonografía y resonancia magnética / Schizencephaly: prenatal diagnosis by means of ultrasonography and magnetic resonance image

La esquizencefalia es una malformación cerebral congénita, de baja incidencia, que se caracteriza por hendiduras en la corteza cerebral comunicando el espacio subaracnoídeo con el sistema ventricular. Se manifiesta en la infancia con alteraciones motoras y convulsiones y en este período se realiza la mayoría de los diagnósticos. Los reportes de diagnóstico en la vida fetal son escasos, pero han aumentado desde el advenimiento de la ultrasonografía de alta resolución (US), la tomografía computada (TC) y la resonancia magnética (RM). Presentamos dos casos en los que se realizó diagnóstico prenatal; a las 28 y 35 semanas de gestación. El diagnóstico se realizó mediante US y RM fetal, en mujeres embarazadas sanas referidas al CERPO por malformación cerebral en US de rutina. Se muestran imágenes de US y RM de ambos fetos y de uno de los recién nacidos. Destacamos la utilidad de la TC o RM para efectuar el diagnóstico de certeza cuando se ha sospechado esta malformación a la US asimismo para efectuar el diagnóstico diferencial con otras entidades como la holoprosencefalia, hidrocefalia y porencefalia, poniendo énfasis en la RM por su mejor resolución y su despligue multiplanar de la anatomía fetal.

Unrecognised ventriculitis/meningitis presenting as hydrocephalus in infancy.

Infantile hydrocephalus due to unrecognized neonatal-onset meningitis/ventriculitis, was studied retrospectively using 1991-1998 chart review. Seventy two patients with hydrocephalus were reviewed. Thirteen infants had hydrocephalus associated with active meningitis/ventriculitis which had remained unrecognized. Active meningitis/ventriculitis was confirmed by the finding of an abnormal lumbar and ventricular CSF with or without positive culture. All had perinatal risk factors and 10/13 had been given antibiotics in the postnatal period. 6/13 infants appeared to be well. The most common presentation was increasing head size. All lumbar and ventricular CSFs were abnormal and 10/13 had positive cultures as well. Imaging revealed hydrocephalus in all. The infants were treated with antibiotics for a mean of 32.8 days before VP shunting. 7/11 were severely disabled. Unrecognized active meningitis/ventriculitis is an important cause of infantile hydrocephalus.

Neurological complications of rabies vaccines.

The rabies vaccines containing neural elements are used in some countries including India. We report three cases that presented with various neurological complications following the use of these vaccines. The presenting manifestations included those of encephalitis, radiculitis and acute inflammatory demyelinating polyradiculoneuropathy. These neurological complications are highlighted so that scientific evidence compels the community to discontinue the use of the neural tissue rabies vaccines. Newer generation cell culture rabies vaccines should be preferred over the neural tissue rabies vaccines for post-exposure prophylaxis.

Sistema ventricular: anatomia e patologia aplicadas ao diagnóstico por imagem / Ventricular system: anatomy and pathological diseases related to the diagnostic imaging

O sistema ventricular encefálico (SV) é composto por câmaraspreenchidas por líquido cefalorraquidiano (LCR), localizadasno interior do encéfalo e revestidas por epêndima.Vários fenômenos patológicos comprometem a morfologia econteúdo dos ventrículos, tais como: malformações congênitas,neoplasias, neurofacomatoses, lesões inflamatórias,hemorragias e processos obstrutivos da circulação liquórica.O objetivo do presente estudo é fazer uma revisão da anatomiae patologia do SV com ênfase para o diagnóstico por imagem

Familial colloid cyst of the third ventricle: a case report and review of the literature

Familial colloid cyst of the third ventricle is very rare. This is one of the two largest families reported and the first in which all affected members are siblings. One asymptomatic sister was found by screening, emphasizing the value of screening. A brother and two sisters from a family consisting of three brothers and three sisters who were diagnosed as having colloid cyst of the third ventricle are presented. The index case like his sister underwent a tumor resection by middle frontal gyrus approach. Brain CT scan was performed for the other first degree family members for screening and colloid cyst was detected in another sister. When two or more members of a family are affected, screening has an important value for detecting other asymptomatic members with colloid cyst of the third ventricle