CHANTER syndrome in the context of pain medication: a case report.

BACKGROUND: CHANTER (Cerebellar Hippocampal and Basal Nuclei Transient Edema with Restricted diffusion) is a recently described syndrome occurring in the context of drug abuse. While clinical findings are rather unspecific (disorientation, unresponsiveness), MR imaging (MRI) discloses a characteristic pattern (restricted diffusion in the basal ganglia and hippocampi, cerebellar oedema and haemorrhage), allowing for timely diagnosis before complications such as cerebellar swelling and herniation do occur. Here we report a case of CHANTER primarily based on imaging findings, as there was no evidence of drug abuse on admission. CASE PRESENTATION: A 62-year-old Patient was admitted to our hospital after being unresponsive at home. Prehospital intubation was performed, which limited neurological assessment. Under these circumstances no obvious symptoms could be determined, i.e. pupils were isocoric and responsive, and there were no signs of seizures. While the initial CT scan was unremarkable, the subsequent MRI scan showed a distinct imaging pattern: moderately enhancing areas in the basal ganglia and hippocampi with diffusion restriction, accompanied by cerebellar haemorrhage and oedema (Figs. 1 and 2). A comprehensive clinical and laboratory work-up was performed, including drug screening, spinal tap, Holter ECG, echocardiography and EEG. The only conspicuous anamnestic finding was a chronic pain syndrome whose medication had been supplemented with opioids two months previously. The opioid medication was discontinued, which led to a rapid improvement in the patient's clinical condition without any further measures. The patient was able to leave the intensive care unit and was discharged 10 days after admission without persistent neurological deficits. CONCLUSION: Familiarity with typical MRI patterns of toxic encephalopathy in patients from high-risk groups, such as drug abusers, is crucial in emergency neuroradiology. In the presence of typical MRI findings, CHANTER syndrome should be included in the differential diagnosis, even if there is no history of drug abuse, to avoid delay in diagnosis and treatment.

The effect of light during embryonic development on laterality and exploration in Western Rainbowfish.

Several factors affect the development of lateralization such as hormones and light exposure during early development. Laterality also often correlates with other behavioral traits. To examine whether there is a common mechanism underlying the development of laterality and other behaviors, we manipulated laterality by exposing embryos of the Western rainbowfish (Melatotaenia australis) to light or continuous darkness during early development and determined whether a shift in laterality was associated with a change in behavior in a novel environment test at two different ages. We found that exposing eggs to darkness led to offspring that displayed significantly less lateralized behavior in the mirror test two weeks after hatching than offspring from eggs exposed to light. Interestingly, the effects of rearing condition were lost by 3 months of age. These data suggest that exposure to light can influence laterality very early in development, but such bias can be overwritten by developmental processes post-hatch. Moreover, our manipulation of laterality apparently had no influence on exploration suggesting independent causal mechanisms. The experimental manipulation of light exposure during development could be a useful tool for enhancing individuals with a specific laterality and behavioral traits to aid future research into the causes and consequences of laterality.

Transdural Skull Base Infiltration by Glioblastoma: Case Report and Review of the Literature.

We report the rare occurrence of a temporal glioblastoma multiforme (GBM) showing transdural tumor extension into adjacent mastoid cells. As the dura mater provides a barrier to intraaxial tumors, GBM seldom penetrates into the skull base, even though it is a high-grade astrocytoma with a tendency to spread. Yet, some mechanisms of GBM-induced skull invasion have been identified, making this entity a very rare but nonetheless relevant differential diagnosis in otherwise ambiguous cases of an intracerebral tumor extending into the skull base. In addition, imaging markers that may assist in distinguishing extra- from intraaxial tumor infiltration of the temporal bone are described.

Scenario-Based Verification of Uncertain MDPs.

We consider Markov decision processes (MDPs) in which the transition probabilities and rewards belong to an uncertainty set parametrized by a collection of random variables. The probability distributions for these random parameters are unknown. The problem is to compute the probability to satisfy a temporal logic specification within any MDP that corresponds to a sample from these unknown distributions. In general, this problem is undecidable, and we resort to techniques from so-called scenario optimization. Based on a finite number of samples of the uncertain parameters, each of which induces an MDP, the proposed method estimates the probability of satisfying the specification by solving a finite-dimensional convex optimization problem. The number of samples required to obtain a high confidence on this estimate is independent from the number of states and the number of random parameters. Experiments on a large set of benchmarks show that a few thousand samples suffice to obtain high-quality confidence bounds with a high probability.

Cochlear Implantation in Patients With Single-sided Deafness After the Translabyrinthine Resection of the Vestibular Schwannoma-Presented at the Annual Meeting of ADANO 2016 in Berlin.

OBJECTIVE: To evaluate effectiveness of the cochlear implant (CI) to facilitate single-sided deafness (SSD) rehabilitation following translabyrinthine resection of the vestibular schwannoma. STUDY DESIGN: Retrospective patient review. SETTING: Single center, University hospital. PATIENTS: Patients with SSD who underwent translabyrinthine resection of a vestibular schwannoma with anatomical preservation of the cochlear nerve and subsequent CI on the same ear. INTERVENTIONS: CI at post-translabyrinthine resection of the acoustic neuroma to treat SSD, and evaluation by retrospective individual case review in a period from 2009 to 2016. MAIN OUTCOME MEASURES: Individual patients' clinical outcome and speech understanding. RESULTS: Thirteen patients were provided CI. In all cases, complete removal of the tumor was achieved and the cochlear nerve was preserved; in one case, the CI was implanted simultaneously. In most cases, the follow-up interval was 2 years. In 9 of 13 cases, the implanted ear achieved capability to understand and discriminate monosyllabic words at 65 dB. Level of speech understanding of over 50% at 65 dB was possible in 7 patients at 12 months after the first fitting of CI. CONCLUSIONS: Under certain conditions, CI was an effective solution to restore hearing in patients with SSD following translabyrinthine access to the skull base. Study with prospective design is required to provide more significant results.

An ultrasound-based navigation system for minimally invasive neck surgery.

Future minimally invasive neck surgery requires a navigation system adapted to the actual intra-operative bedding of the patient. The detection of the bedding-caused tissue shift is essential for a safe orientation for the surgeon new endoscopic operation procedures in neck surgery. It is essential to visualize the relation between important anatomic landmarks and operation instruments at any time. Within the scientific project SACAS we focus on developing an ultrasound supported navigation system based on preoperative imaging which considers the intra-operative tissue shift. A rotatable, flexible neck-model provides the basis for our analysis to evaluate the tissue shift and to invent the new navigation system for endoscopic neck surgery. The total registration error of the system was 2 mm.

Rotatable flexible neck-model for the evaluation of minimally invasive operation procedures with the help of an ultrasound-based navigation system.

Future minimally invasive neck surgery requires a navigation system adapted to the actual intraoperative bedding of the patient. The detection of the bedding-caused tissue shift is essential for a safe orientation for the surgeons' new endoscopic operation procedures in neck surgery. It is essential to visualize the relation between important anatomic landmarks and operation instruments at any time. Within the scientific project SACAS we focus on developing an ultrasound supported navigation system based on preoperative imaging which considers the intraoperative tissue shift. A rotatable, flexible neck-model provides the basis for our analyses to evaluate the tissue shift and to invent the new navigation system for endoscopic neck surgery. The total registration error of the system was 2 mm.

Helicusin E, isochromophilone X and isochromophilone XI: new chloroazaphilones produced by the fungus Bartalinia robillardoides strain LF550.

Microbial studies of the Mediterranean sponge Tethya aurantium led to the isolation of the fungus Bartalinia robillardoides strain LF550. The strain produced a number of secondary metabolites belonging to the chloroazaphilones. This is the first report on the isolation of chloroazaphilones of a fungal strain belonging to the genus Bartalinia. Besides some known compounds (helicusin A (1) and deacetylsclerotiorin (2)), three new chloroazaphilones (helicusin E (3); isochromophilone X (4) and isochromophilone XI (5)) and one new pentaketide (bartanolide (6)) were isolated. The structure elucidations were based on spectroscopic analyses. All isolated compounds revealed different biological activity spectra against a test panel of four bacteria: three fungi; two tumor cell lines and two enzymes.

Water input requirements of the rapidly shrinking Dead Sea.

The deepest point on Earth, the Dead Sea level, has been dropping alarmingly since 1978 by 0.7 m/a on average due to the accelerating water consumption in the Jordan catchment and stood in 2008 at 420 m below sea level. In this study, a terrain model of the surface area and water volume of the Dead Sea was developed from the Shuttle Radar Topography Mission data using ArcGIS. The model shows that the lake shrinks on average by 4 km(2)/a in area and by 0.47 km(3)/a in volume, amounting to a cumulative loss of 14 km(3) in the last 30 years. The receding level leaves almost annually erosional terraces, recorded here for the first time by Differential Global Positioning System field surveys. The terrace altitudes were correlated among the different profiles and dated to specific years of the lake level regression, illustrating the tight correlation between the morphology of the terrace sequence and the receding lake level. Our volume-level model described here and previous work on groundwater inflow suggest that the projected Dead Sea-Red Sea channel or the Mediterranean-Dead Sea channel must have a carrying capacity of >0.9 km(3)/a in order to slowly re-fill the lake to its former level and to create a sustainable system of electricity generation and freshwater production by desalinization. Moreover, such a channel will maintain tourism and potash industry on both sides of the Dead Sea and reduce the natural hazard caused by the recession.