Confined anterior cerebral artery infarction manifesting as isolated unilateral axial weakness

Basic research and clinical progress of sepsis-associated encephalopathy

Sepsis-associated encephalopathy (SAE), a major cerebral complication of sepsis, occurs in 70% of patients admitted to the intensive care unit (ICU). This condition can cause serious impairment of consciousness and is associated with a high mortality rate. Thus far, several experimental screenings and radiological techniques (e.g., electroencephalography) have been used for the non-invasive assessment of the structure and function of the brain in patients with SAE. Nevertheless, the pathogenesis of SAE is complicated and remains unclear. In the present article, we reviewed the currently available literature on the epidemiology, clinical manifestations, pathology, diagnosis, and management of SAE. However, currently, there is no ideal pharmacological treatment for SAE. Treatment targeting mitochondrial dysfunction may be useful in the management of SAE.

Sepsis and Cerebral Dysfunction: BBB Damage, Neuroinflammation, Oxidative Stress, Apoptosis and Autophagy as Key Mediators and the Potential Therapeutic Approaches

Sepsis-associated cerebral dysfunction is complex pathophysiology, generated from primary infections that are developed elsewhere in the body. The neonates, elderly population and chronically ill and long-term hospitalized patients are predominantly vulnerable to sepsis and related cerebral damage. Generally, electrophysiological recordings, severity and sedation scales, computerized imaging and spectroscopy techniques are used for its detection and diagnosis. About the underlying mechanisms, enhanced blood-brain barrier permeability and metalloprotease activity, tight junction protein loss and endothelial cell degeneration promote the influx of inflammatory and toxic mediators into the brain, triggering cerebrovascular damage. An altered neutrophil count and phenotype further dysregulate the normal neuroimmune responses and neuroendocrine stability via modulated activation of protein kinase C-delta, nuclear factor kappa-B and sphingolipid signaling. Glial activation, together with pro-inflammatory cytokines and chemokines and the Toll-like receptor, destabilize the immune system. Moreover, superoxides and hydroperoxides generate oxidative stress and perturb mitochondrial dynamics and ATP synthesis, propagating neuronal injury cycle. Activated mitochondrial apoptotic pathway, characterized by increased caspase-3 and caspase-9 cleavage and Bax/Bcl2 ratio in the hippocampal and cortical neurons, stimulate neurocognitive impairments. Additionally, altered LC3-II/I and P62/SQSTM1, p-mTOR, p-AMPK1 and p-ULK1 levels and dysregulated autophagosome-lysosome fusion decrease neuronal and glial energy homeostasis. The therapies and procedures for attenuating sepsis-induced brain damage include early resuscitation, cerebral blood flow autoregulation, implantable electric vagus nerve stimulation, antioxidants, statins, glucocorticoids, neuroimmune axis modulators and PKCδ inhibitors. The current review enumerates the pathophysiology of sepsis-induced brain damage, its diagnosis, the role of critical inducers and mediators and, ultimately, therapeutic measures attenuating cerebrovascular degeneration.

Magnetic resonance angiography of hypoplastic A1 segment of anterior cerebral artery at 3.0-Tesla in Andhra Pradesh population of India

Pre-communicating or A1 segment of anterior cerebral artery (A1ACA) hypoplasia can negotiate the anterior cerebral circulation. Not many studies have been examined the association of hypoplastic A1ACA and cerebral ischemic stroke (CIS). In this study the authors' want to accomplish the relationship between hypoplastic A1ACA and outcomes among the patients with CIS in Andhra Pradesh population of India. Retrospective review of prospectively identified 201 adult patients with CIS from 2015 to 2017 was achieved. Patients underwent 3.0T intracranial magnetic resonance angiography were compared with clinical and radiological aspects between male and female cases of A1ACA hypoplasia with associated variations in the circle of Willis. The obtained data was statistically analysed using SPSS software version 16.0 for Windows and P-value <0.05 was considered as significant. Chi-square test was applied to find out the association between the sex and incidence of hypoplastic A1ACA. Sixty-four of 201 patients with A1ACA hypoplasia with no aplastic cases were recorded. It was found to be more in males than females and common on right than left side. Frequent neurological indications such as headache, dizziness, visual instability, nausea, weakness of extremities and seizure were noted and most cases were associated with CIS. Hypoplastic A1ACA often associated with ischemia of terminal branches of ipsilateral ACA which is compromised by the blood flow via contralateral ACA. In this study, though the CIS is not directly related to hypoplastic A1ACA, any alterations in A1 segment is a considerable risk factor of stroke.