Cine phase-contrast magnetic resonance imaging evaluation of cerebrospinal fluid flow dynamics in healthy pediatric subjects / Avaliação da dinâmica do fluxo do líquido cerebrospinal por cine-ressonância magnética com contraste de fase em crianças saudáveis

Abstract Objective: To evaluate cerebrospinal fluid dynamics, using cine phase-contrast magnetic resonance imaging (cine-PC MRI), in healthy pediatric subjects, determining the normal flow values in this population, as well as identifying differences related to age, sex, and body surface area. Materials and Methods: This was a descriptive cross-sectional study involving 32 healthy children and adolescents, in whom the flow of cerebrospinal fluid through the cerebral aqueduct was evaluated quantitatively with cine-PC MRI. We used specialized software to analyze the images obtained with cine-PC MRI, drawing a region of interest on the aqueduct. A flow-time curve was obtained, as were automated measurements of the various parameters. Results: The following normal (mean) values were obtained: net flow, 1.10 ± 0.99 mL/m; stroke volume, 12.2 ± 10.1 μL/cycle; mean velocity, 0.72 ± 1.00 cm/s; peak systolic velocity, 5.28 ± 2.30 cm/s; peak diastolic velocity, 4.51 ± 1.77 cm/s. These values were not affected by age or sex. In addition, body surface area was not found to correlate significantly with mean velocity or stroke volume. Conclusion: In children and adolescents, the basic cerebrospinal fluid flow parameters, as determined by cine-PC MRI, appear to be independent of age and sex.

Resumo Objetivo: Avaliar a dinâmica do fluxo do líquido cerebrospinal por cine-ressonância magnética com contraste de fase em crianças saudáveis, para determinar os valores normais de fluxo nesta população, bem como a diferença entre medições distintas de acordo com idade, sexo ou área da superfície corporal. Materiais e Métodos: Convocamos 32 crianças saudáveis em uma análise descritiva de prevalência para a avaliação quantitativa do fluxo do líquido cerebrospinal pelo aqueduto de Sylvius. A análise foi realizada por meio de software especializado, desenhando uma região de interesse no aqueduto. Uma curva de fluxo-tempo e medições automáticas de diversos parâmetros foram obtidas. Resultados: Os seguintes valores normais foram obtidos: fluxo efetivo de 1,10 ± 0,99 mL/m; volume médio de 12,2 ± 10,1 μL/ciclo; velocidade média de 0,72 ± 1,00 cm/s; pico de velocidade sistólica de 5,28 ± 2,30 cm/s; pico de velocidade diastólica de 4,51 ± 1,77 cm/s. Esses valores não foram afetados pela idade ou sexo das crianças. Além disso, não foi encontrada correlação significativa entre a área corporal, a velocidade média e o volume sistólico. Conclusão: De modo geral, os parâmetros básicos do fluxo do líquido cerebrospinal independem de idade e sexo em crianças.

Evaluación del cerebro fetal: nuevas herramientas / Fetal brain assessment: new tools

RESUMEN La evaluación del cerebro fetal es un punto imprescindible en el ultrasonido obstétrico, por la gran cantidad de malformaciones que pueden ser diagnosticadas. La guía de ISUOG nos brinda los cortes elementales para la sospecha de la patología cerebral; pero, podemos ampliar y mejorar nuestro ultrasonido con la visualización de estructuras fácilmente reproducibles, tales como el complejo anterior, cuerpo calloso, cisura de Silvio y el cuarto ventrículo. Presentamos algunas herramientas para complementar la evaluación del cerebro fetal.

ABSTRACT The evaluation of the fetal brain is an essential point in obstetric ultrasound due to the large number of malformations that can be diagnosed. The ISUOG guide provides us with the elementary sections for the suspicion of brain pathology; but we can extend and improve our ultrasound with the visualization of easily reproducible structures, such as the anterior complex, corpus callosum, Sylvian fissure and the fourth ventricle. We present some tools to complement the assessment of the fetal brain.

A rare case report: successful outcome of a patient at near term pregnancy with maternal chronic obstructive hydrocephalus due to tubercular meningitis

The incidence of tubercular meningitis leading to obstructive hydrocephalus is extremely rare accounting for 1% cases and is even rarer during pregnancy. A 20-year-old 2nd Gravida presented at 32 weeks gestation with complaints of intermittent headache, decreased vision since 3 months and irrelevant talks and agitated behavior since 1 day. On examination patient had stable vital signs but constant irritable behavior. Obstetric examination revealed a pregnancy corresponding to 32 weeks with a live fetus. Patient had a past history of Anti-tubercular therapy taken 2 years back for tubercular meningitis. Neurological examination revealed a GCS of 12/15 and Ophthalmologic examination revealed patient to be having only Perception of Light with optic atrophy on fundoscopy. NCCT head revealed moderate dilatation of bilateral ventricles and 3rd ventricle without any periventricular ooze suggestive of Chronic Obstructive Hydrocephalus. Supportive therapy was instituted with Dexamethasone and Mannitol infusion after Neurosurgical consultation along with antenatal care. Decision for termination of pregnancy was taken at 35 weeks by an elective caesarean section with simultaneous ventriculo-peritoneal shunt insertion by neurosurgical team under general anesthesia. A live male baby of 2.25 kg was delivered. Patient with baby was discharged on 10th post-operative day. Obstructive hydrocephalous developing post tubercular meningitis in pregnancy is a rare event. Caesarean section was done along with shunt surgery in our case. Very few cases have been reported in the medical literature so far.

Role of c-Jun N-terminal kinase in activation of astrocytes in midbrain periaqueductal gray of rats with neuropathic pain / 中华麻醉学杂志

Objective To evaluate the role of c-Jun N-terminal kinase (JNK) in activation of astrocytes in midbrain periaqueductal gray (PAG) of rats with neuropathic pain.Methods A total of 72 pathogen-free male Sprague-Dawley rats,aged 9 weeks,weighing 160-200 g,were divided into 4 groups using a random number table:control group (group C,n =8),neuropathic pain group (group NP,n =40),dimethyl sulfoxide control group (group DS,n =12) and JNK inhibitor SP600125 group (group SP,n=12).Neuropathic pain was produced by chronic constriction injury (CCI).At 14 days after CCI,10 nmol JNK inhibitor SP600125 0.5 μl was intraperitoneally injected into the PAG in group SP,and 10％ dimethyl sulfoxide 0.5 μl was given instead in group DS.Eight rats were selected in group C,before CCI and at 3,7,14 and 21 days after CCI in group NP,and in DS and SP groups,and the mechanical pain threshold was measured before CCI,before administration on 14 days after CCI and at 30,45,60,75 and 90 min after administration.The rats in group C were sacrificed after the end of measurement of the mechanical pain threshold,and brains were removed for determination of phosphorylated JNK (p-JNK) and glial fibrillary acidic protein expression (by Western blot) in PAG region.The rats in group NP were sacrificed after the end of measurement of the mechanical pain threshold at each time point,and brains were removed for detection of p-JNK expression in PAG region.Four rats in DS and SP groups were sacrificed after the last measurement of the mechanical pain threshold at 45 min after administration,and brains were removed for determination of glial fibrillary acidic protein expression in PAG region.Results Compared with group C,the mechanical pain threshold was significantly decreased at each time point after CCI,and the expression of p-JNK was up-regulated at 7-21 days after CCI in group NP (P＜0.01).Compared with group DS,the mechanical pain threshold was significantly increased at 30 min after administration,and GFAP expression was down-regulated at 45 min after administration in group SP (P＜ 0.01).The mechanical pain threshold was significantly higher at 30-75 min after administration than before administration in group SP (P＜0.01).Conclusion The mechanism underlying activation of astrocytes in PAG is related to activating JNK in the rats with neuropathic pain.

Effect of opioid switch from morphine to sufentanil on expression of μ-opioid receptors in midbrain periaqueductal gray of rats / 中华麻醉学杂志

Objective To evaluate the effect of the opioid switch from morphine to sufentanil on the expression of μ-opioid receptors in the midbrain periaqueductal gray (PAG) of rats.Methods Forty healthy male Wistar rats,aged 8 weeks,weighing 250-290 g,were randomly assigned into 5 groups (n=8 each) using a random number table:control group (group C),7 day sufentanil group (group S),7 day morphine group (group M),14 day morphine group (group MM),and 14 day alternate administration of morphine and sufentanil group (group MS).Normal saline 2 ml/kg,sufentanil 0.01 mg/kg and morphine 10 mg/kg were injected subcutaneously in the cervical region twice a day for 7 consecutive days in C,S and M groups,respectively.In group MM,morphine 10 mg/kg was injected subcutaneously in the cervical region twice a day for 14 consecutive days.In group MS,morphine 10 mg/kg was injected subcutaneously in the cervical region twice a day for 7 consecutive days (1st-7th days),and sufentanil 0.01 mg/kg was then injected subcutaneously in the cervical region twice a day for 7 consecutive days (8th-14th days).The tail flick latency (TFL) to a thermal nociceptive stimulus was measured at 15 and 30 min after the initial administration every day.After the last administration,the rats were sacrificed,and the midbrain PAG was isolated for determination of the expression of the μ-opioid receptor and μ-opioid receptor mRNA using Western blot and real-time reverse transcriptase polymerase chain reaction,respectively.Results Compared with group C,the TFL was significantly prolonged on 1st-6th days after the beginning of administration in M,MM and MS groups,the TFL was significantly prolonged on 1st-7th days after the beginning of administration in group S,and the expression of the μ-opioid receptor and μ-opioid receptor mRNA in the midbrain PAG was significantly down-regulated in M,MM and MS groups (P＜0.05).Compared with group MM,the TFL was significantly prolonged on 8th-14th days after the beginning of administration,and the expression of the μ-opioid receptor and μ-opioid receptor mRNA in the midbrain PAG was significantly up-regulated in group MS (P＜0.05).Conclusion The mechanism by which the opioid switch from morphine to sufentanil reduces morphine tolerance is related to enhanced activity of μ-opioid receptors in the midbrain PAG of rats.

Research of normal cerebrospinal fluid flow of the middle aqueduct by spin labeling at MR imaging / 重庆医学

Objective To measure the normal cerebrospinal fluid of the midbrain aqueduct peak velocity of different age groups by using magnetic resonance imaging (MRI) time‐spatial labeling inversion pulse (time‐SLIP) ,and to discuss the flow law of CSF . Methods Forty‐one cases of healthy volunteers ,including 23 cases of male ,18 cases of female ,aged 7 -73 .Patients were divided into 4 groups:7- 0 .05) between age .Conclusion In the midbrain aqueduct ,CSF is two‐way flow and supports the CSF of the pulsatile flow theory ;MRI sequence of time‐SLIP could measure CSF velocity and display the turbulence fluiding .

Hidrocefalia ligada al cromosoma X o síndrome de Bickers-Adams: presentación de un caso / X-linked hydrocephalus or Bickers-Adams syndrome: a case presentation

Introducción: la hidrocefalia es una enfermedad con transmisión recesiva ligada al cromosoma X, y una tasa de recurrencia del 50 por ciento en los fetos masculinos. Es la forma más común genética de hidrocefalia congénita, con una incidencia de 1 / 30, 000 nacimientos de varones. Se caracteriza por la dilatación de los ventrículos laterales y el retraso mental, suelen ser graves. Caso clínico: recién nacido que al momento de su nacimiento se observa con macrocefalia evidente con antecedente familiar de un primo con el mismo problema, con igual cuadro clínico y la misma neuroimagen por lo que se diagnosticó una hidrocefalia ligada al cromosoma X. Conclusiones: el caso que se presentó por sus características clínicas y el estudio de scanner cerebral se pudo llegar a un diagnóstico de hidrocefalia ligada al cromosoma X o llamado síndrome de Bickers-Adams.

Introduction: hydrocephalus (HL) is a recessive transmission disease linked to X- chromosome. It presents a 50 % recurrence rate in male fetuses. It is the commonest form of congenital hydrocephalus, with an incidence of 1/30 000 male births. It is characterized by dilation of lateral ventricles and mental retardation, usually severe. Clinical case: a newborn at birth is observed with evident macrocephaly with a family history of a cousin with the same problem. X-linked hydrocephalus (HLX) was diagnosed. Conclusions: a case of X- linked hydrocephalus or Bickers-Adams syndrome was presented, diagnosed by their clinical characteristics and brain scanner study.

Transtorno de aprendizagem e alteração cognitiva secundária a hidrocefalia por estenose do aqueduto de Sylvius: relato de caso / Learning disorder and cognitive impairment secondary to hydrocephalus due to stenosis of aqueduct of Sylvius: case report

JUSTIFICATIVA E OBJETIVOS: A estenose do aqueduto de Sylvius é responsável por um terço dos casos congênitos de hidrocefalia.A hipertensão intracraniana com consequente dilatação ventricular pode comprometer o desenvolvimento neuropsicomotor. Em crianças em idade escolar com alterações cognitivas ou comportamentais de início recente, sem causa aparente, este é um diagnóstico a ser pensado. Exames de imagem são fundamentais para a confirmação diagnóstica. Com tratamento adequado é esperada evolução favorável. O objetivo deste estudo foi relatar um caso de hidrocefalia por estenose do aqueduto de Sylvius como causa de transtorno de aprendizagem e alteração cognitiva e discutir seus aspectos clínicos, evolutivos e terapêuticos, ressaltando a importância da avaliação criteriosa de alterações neuropsiquiátricas em crianças em idade escolar. RELATO DO CASO: Paciente do sexo masculino, 10 anos, apresentando quadro progressivo de baixo rendimento escolar, déficit de concentração e compreensão, apatia e isolamento social há cinco meses. Após o diagnóstico de hidrocefalia por estenose do aqueduto de Sylvius foi submetido à cirurgia para derivação liquórica ventrículo peritoneal, evoluindo com melhora progressiva. CONCLUSÃO: Os efeitos da hidrocefalia em crianças podem comprometer o desenvolvimento cerebral, portanto, o diagnóstico precoce, a fim de instituir a terapêutica adequada, são essências para a reabilitação neuropsicomotora nesses pacientes.

BACKGROUND AND OBJECTIVES: Sylvius aqueduct stenosis accounts for one third of congenial hydrocephalus cases. Intracranial hypertension with subsequent ventricular dilatation may impair neuro-psychomotor development. In school-aged children with cognitive and/or behavioral alterations of recent onset, without apparent cause, this is a diagnosis to be considered. Imaging tests are of crucial importance for diagnostic confirmation. Favorable outcomes are expected with an effective treatment. The aim of this study was to report a case of hydrocephalus due to Sylvius aqueduct stenosis as a cause of learning disorders and cognitive impairment and to discuss its clinical, evolutionary and therapeutic aspects, emphasizing the importance of a careful assessment of neuropsychiatric alterations in school-aged children. CASE REPORT: A 10-year-old male patient that presented progressive history of poor academic performance, deficits of concentration and comprehension, apathy and social isolation for five months. The diagnosis was hydrocephalus due to Sylvius aqueduct stenosis; the patient underwent ventriculoperitoneal shunting surgery and there was significant improvement. CONCLUSION: The effects of hydrocephalus in children can impair brain development; therefore, early diagnosis to institute appropriate therapy is essential for neuro-psychomotor rehabilitationin these patients.

Comparative study of cerebrospinal fluid flow in the cerebral aqueduct between empty sella syndrome and normal volunteer / 中国医师进修杂志

Objective To compar the cerebrospinal fluid (CSF) flow between empty sella syndrome (ESS) and normal volunteer in the cerebral aqueduct with MRI in phase contrast cine mode. Methods Thirty-eight ESS patients (ESS group) and 38 normal volunteers (control group ) were involved in this study.The aqueduct CSF flow image was positioned perpendicularly to the midbrain aqueduct at the middle sagittal T1WI or T2WI image. The waveforms were analyzed for the flow direction, flow rate, flow volume rate and cardiac cycle. Results The CSF flow of the aqueduct in control group and ESS group had two directions which was downward flow during the systolic period and upward flow during the diastolic period of the cardiac cycle. The.systolic period downward peak flow rate, diastolic period upward peak flow rate, mean downward flow rate, mean upward flow rate and mean flow rate were (5.231 ± 0.262), (4.902 ± 0.281 ),(3.083 ± 0.191 ), (3.032 ± 0.151 ), (3.151 ± 0.162) cm/s in control group, and (6.244 ± 0.356), (6.091 ±0.430), (3.916 ± 0.196), (3.812 ± 0.273 ), (3.690 ± 0.291 ) cm/s in ESS group respectively,and there was no significant difference between the two groups ( P ＞ 0.05 ). The systolic period downward peak flow volume rate, diastolic period upward peak flow volume rate, mean downward flow volume rate,mean upward flow volume rate and mean flow volume rate were (0.050 ± 0.003 ), (0.050 ± 0.004), (0.030± 0.002), (0.031 ±0.002), (0.030 ± 0.003 ), ( 0.004 ± 0.001 )ml/s in control group, and (0.058 ± 0.003 ), (0.063 ± 0.005),(0.039 ±0.002), (0.038 ±0.003), (0.038 ±0.003), (0.004 ±0.001) ml/s in ESS group respectively,and there was no significant difference between the two groups(P ＞ 0.05 ). The correspond cardiac cycle of systolic period downward peak flow rate, correspond cardiac cycle of diastolic period upward peak flow rate, mean cardiac cycle were (40.890 ± 37.096), (501.026 ± 19.374), (719.511 ± 14.946) ms in control group,and (35.921 ±6.218), (531.553 ± 16.764), (770.700 ±21.579) ms in ESS group,and there was no significant difference between the two groups (P ＞ 0.05 ). Conclusion Part of CSF flows into the area of saddle in ESS patients, but it has no effect on CSF indexes in area of cerebral aqueduct.

Effect of dexmedetomidine on norepinephrine release in midbrain periaqueductal gray in a rat model of incisional pain / 中华麻醉学杂志

Objective To investigate the effect of dexmedetomidine on norepinephrine(NE)release in midbrain periaqueductal gray(PAG)in a rat model of incisional pain.Methods Twenty-four male Wistar rats in which microdialvsis catheter was successfully placed in the ventrolateral region of PAG without complications were randomly divided into 4 groups(n=6 each):group control(group C);group incisional pain(group IP);group dexmetomidine(group D)and group dexmedetomidine+yohimbine(group DY).Incisional pain was induced by an incision made into the plantar surface of left hindpaw in IP,D,DY groups.Dexmedetomidine 30 μg/kg and dexmedetomidine 30 μg/kg+yohimbine 0.5 mg/kg were given intraperitoneally at 15 min before plantar incision in group D and group DY respectively.Mechanical paw withdrawal threshold(MWT)to von Frey filament stimulation was measured at 30 min before(baseline)and 1,2,3,4 h after operation in C,IP,D groups,and at 30 min before(baseline),and 1 h after operation in group DY.Dialysate samples were collected at 30 min before(baseline)and at evcry 30 min after operation for 4 h via cerebral microdialysis catheter for determination of the NE concentration in C,IP,D groups,and at 30 min before(baseline),30,60 min after operation in group DY.Results Incisional pain significantly decreased MWT and increased the NE concentration in dialysate in group IP.Dexmedetomidine premedication significantly inhibited mechanical hyperalgesia and attenuated incisional pain-induced increase in the NE concentration in dialysate in group D.Yohimbine counteracted effects of dexmedetomidine.Conclusion Dexmedetomidine has analgesic effect though inhibition of NE release from PAG.