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Takahashi N, Mishima T, Nakamura D, Fujioka S, Tsuboi Y. Three Cases of Subdural Hematoma with Transient Neurological Deficits: Importance of Sulcal Hyperintensity in Magnetic Resonance Imaging Fluid-attenuated Inversion Recovery Images. Intern Med 2025; 64:1101-1106. [PMID: 39231672 PMCID: PMC12021498 DOI: 10.2169/internalmedicine.4001-24] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2024] [Accepted: 07/07/2024] [Indexed: 09/06/2024] Open
Abstract
Patient 1 (82 years old) had recurrent weakness and numbness in the left upper extremity, Patient 2 (71 years old) had transient dysarthria, and Patient 3 (70 years old) had transient apraxia of speech. Transient ischemic attack (TIA) was suspected; however, all three women had a history of head trauma before the symptom onset, and magnetic resonance imaging revealed subdural hematomas near the responsible lesions associated with sulcal hyperintensity (SHI) in the cerebral sulcus near the hematoma. Patients 1 and 2 improved spontaneously, whereas Patient 3 improved with antiseizure medication. Subdural hematomas associated with SHI may have transient focal neurological deficits that manifest through a mechanism unlike TIA.
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Affiliation(s)
| | - Takayasu Mishima
- Department of Neurology, Faculty of Medicine, Fukuoka University, Japan
| | - Daito Nakamura
- Department of Neurology, Faculty of Medicine, Fukuoka University, Japan
| | - Shinsuke Fujioka
- Department of Neurology, Faculty of Medicine, Fukuoka University, Japan
| | - Yoshio Tsuboi
- Department of Neurology, Faculty of Medicine, Fukuoka University, Japan
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Lee SY, Lee SJ, Kim SS, Jun HS, Oh C, Lin C, Phi JH. Post-traumatic Transient Neurological Dysfunction: A Proposal for Pathophysiology. J Neurotrauma 2024; 41:e1695-e1707. [PMID: 38687331 DOI: 10.1089/neu.2021.0470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/02/2024] Open
Abstract
Unexplained neurological deterioration is occasionally observed in patients with traumatic brain injuries (TBIs). We aimed to describe the clinical features of post-traumatic transient neurological dysfunction and provide new insight into its pathophysiology. We retrospectively collected data from patients with focal neurological deterioration of unknown origin during hospitalization for acute TBI for 48 consecutive months. Brain imaging, including computed tomography, diffusion-weighted imaging and perfusion-weighted imaging, and electroencephalography were conducted during the episodes. Fourteen (2.0%) patients experienced unexplained focal neurological deterioration among 713 patients who were admitted for traumatic intracranial hemorrhage during the study period. Aphasia was the predominant symptom in all patients, and hemiparesis or hemianopia was accompanied in three patients. These symptoms developed within 14 days after trauma. Structural imaging did not show any significant interval change, and electroencephalography showed persistent arrhythmic slowing in the corresponding hemisphere in most patients. Perfusion imaging revealed increased cerebral blood flow in the symptomatic hemisphere. Surgical intervention and anti-seizure medications were ineffective in abolishing the symptoms. The symptoms disappeared spontaneously after 4 h to 1 month. Transient neurological dysfunction (TND) can occur during the acute phase of TBI. Although TND may last longer than a typical transient ischemic attack or seizure, it eventually resolves regardless of treatment. Based on our observation, we postulate that this is a manifestation of spreading depolarization occurring in the injured brain, which is analogous to migraine aura.
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Affiliation(s)
- Seo-Young Lee
- Department of Neurology, Kangwon National University College of Medicine, Chuncheon, Korea
- Department of Neurology, Kangwon National University Hospital, Chuncheon, Korea
- Department of Critical Care Medicine, Kangwon National University Hospital, Chuncheon, Korea
| | - Seung Jin Lee
- Department of Neurosurgery, Kangwon National University College of Medicine, Chuncheon, Korea
- Department of Neurosurgery, Kangwon National University Hospital, Chuncheon, Korea
| | - Sam Soo Kim
- Department of Radiology, Kangwon National University College of Medicine, Chuncheon, Korea
| | - Hyo Sub Jun
- Department of Neurosurgery, Kangwon National University College of Medicine, Chuncheon, Korea
- Department of Neurosurgery, Kangwon National University Hospital, Chuncheon, Korea
| | - Chungkun Oh
- Department of Neurology, Kangwon National University Hospital, Chuncheon, Korea
| | - Chen Lin
- Department of Biomedical Sciences and Engineering, National Central University, Taoyuan city, Taiwan
| | - Ji Hoon Phi
- Department of Neurosurgery, Seoul National University College of Medicine, Seoul, Korea
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Ishida S, Nitta N, Yoshida K. Focal aware somatosensory seizures with paresis as a complication of surgery for chronic subdural hematoma. Epilepsy Behav Rep 2023; 24:100621. [PMID: 37790214 PMCID: PMC10543690 DOI: 10.1016/j.ebr.2023.100621] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Revised: 09/20/2023] [Accepted: 09/22/2023] [Indexed: 10/05/2023] Open
Abstract
There has been only one previous published report of focal aware somatosensory seizures with paresis as a postoperative complication of chronic subdural hematoma (cSDH). This is the second case report of this condition captured on electroencephalography (EEG) as a postoperative complication of cSDH. A 76-year-old man with no history of epilepsy was taken to the emergency department of Shiga University of Medical Science Hospital because of transient weakness of the lower extremities. Head computed tomography showed bilateral cSDH that was larger on the left. Seven days after burr-hole evacuation of the left cSDH, the patient experienced a brief clonic seizure of the right hand without postoperative recurrence of cSDH. He then experienced a tingling sensation in, followed by clumsiness and weakness of, the right upper extremity without fluctuations in consciousness or convulsive movements. These symptoms appeared repeatedly, with intermittent improvement, persisting for 6 days after onset. Scalp EEG showed an electrographic seizure in the left central area, suggesting that the symptoms corresponded to focal aware somatosensory seizures with paresis. The symptoms and epileptiform patterns and electrographic seizures on the EEG disappeared with antiseizure medications.
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Affiliation(s)
- Shohei Ishida
- Department of Neurosurgery, Shiga University of Medical Science, Shiga, Japan
- Department of Neurosurgery, Kohka Public Hospital, Shiga, Japan
| | - Naoki Nitta
- Department of Neurosurgery, Shiga University of Medical Science, Shiga, Japan
| | - Kazumichi Yoshida
- Department of Neurosurgery, Shiga University of Medical Science, Shiga, Japan
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Stubbs DJ, Davies B, Hutchinson P, Menon DK. Challenges and opportunities in the care of chronic subdural haematoma: perspectives from a multi-disciplinary working group on the need for change. Br J Neurosurg 2022; 36:600-608. [PMID: 35089847 DOI: 10.1080/02688697.2021.2024508] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Accepted: 12/27/2021] [Indexed: 12/25/2022]
Abstract
INTRODUCTION A chronic subdural haematoma (cSDH) is a collection of altered blood products between the dura and brain resulting in a slowly evolving neurological deficit. It is increasingly common and, in high income countries, affects an older, multimorbid population. With changing demographics improving the care of this cohort is of increasing importance. METHODS We convened a cross-disciplinary working group (the 'Improving Care in Elderly Neurosurgery Initiative') in October 2020. This comprised experts in neurosurgical care and a range of perioperative stakeholders. An Implementation Science framework was used to structure discussions around the challenges of cSDH care within the United Kingdom. The outcomes of these discussions were recorded and summarised, before being circulated to all attendees for comment and refinement. RESULTS The working group identified four key requirements for improving cSDH care: (1) data, audit, and natural history; (2) evidence-based guidelines and pathways; (3) shared decision-making; and (4) an overarching quality improvement strategy. Frequent transfers between care providers were identified as impacting on both perioperative care and presenting a barrier to effective data collection and teamworking. Improvement initiatives must be cognizant of the complex, system-wide nature of the problem, and may require a combination of targeted trials at points of clinical equipoise (such as anesthetic technique or anticoagulant management), evidence-based guideline development, and a cycle of knowledge acquisition and implementation. CONCLUSION The care of cSDH is a growing clinical problem. Lessons may be learned from the standardised pathways of care such as those as used in hip fracture and stroke. A defined care pathway for cSDH, encompassing perioperative care and rehabilitation, could plausibly improve patient outcomes but work remains to tailor such a pathway to cSDH care. The development of such a pathway at a national level should be a priority, and the focus of future work.
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Affiliation(s)
- Daniel J Stubbs
- Department of Medicine, University Division of Anaesthesia, Cambridge University Hospital, Cambridge
- Department of Engineering, Healthcare Design Group, Cambridge, UK
| | - Benjamin Davies
- Department of Academic Neurosurgery, Department of Neurosurgery, Cambridge University Hospital, Cambridge, UK
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Balachandar A, Carpani F, Del Campo M, Mandell D. Subdural Hematoma-Induced Cortical Perforator Thrombosis Causing Ischemic Strokes. Stroke 2022; 53:e381-e382. [PMID: 35616022 DOI: 10.1161/strokeaha.122.039482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Arjun Balachandar
- Division of Neurology, Department of Medicine, University of Toronto, ON, Canada. (A.B., F.C., M.D.C.).,Division of Neuroradiology, University of Toronto, ON, Canada. (A.B., F.C., M.D.C.)
| | - Federico Carpani
- Division of Neurology, Department of Medicine, University of Toronto, ON, Canada. (A.B., F.C., M.D.C.).,Division of Neuroradiology, University of Toronto, ON, Canada. (A.B., F.C., M.D.C.)
| | - Martin Del Campo
- Division of Neurology, Department of Medicine, University of Toronto, ON, Canada. (A.B., F.C., M.D.C.).,Division of Neuroradiology, University of Toronto, ON, Canada. (A.B., F.C., M.D.C.)
| | - Daniel Mandell
- Department of Medical Imaging, University of Toronto, ON, Canada. (D.M.)
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Jain V, Remley W, Mohan A, Leone EL, Taneja S, Busl K, Almeida L. Nonepileptic, Stereotypical, and Intermittent Symptoms After Subdural Hematoma Evacuation. Cureus 2021; 13:e18361. [PMID: 34725611 PMCID: PMC8555749 DOI: 10.7759/cureus.18361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/27/2021] [Indexed: 11/30/2022] Open
Abstract
Transient neurological deficits can occur in the setting of subdural hemorrhages with subsequent unremarkable electrodiagnostic and radiological evaluation. This scenario is rare and can be difficult for physicians to interpret. These transient neurological deficits are thought to result from relative ischemia, secondary to a lesser-known concept known as cortical spreading depolarization. These transient neurological deficits are thought to result from relative ischemia, secondary to a lesser-known concept known as cortical spreading depolarization, which may present clinically as nonepileptic, stereotypical, and intermittent symptoms (NESIS). In these instances, patients are often misdiagnosed as epileptics and committed to long-term antiseizure drugs. We present a 51-year-old patient developing acute global aphasia following the evacuation of a subdural hematoma, with no significant findings on laboratory, microbiological, electrodiagnostic, or radiological evaluation. The patient experienced spontaneous improvement and returned to baseline in the subsequent weeks. Increased awareness of NESIS as a cortical spreading depolarization phenomenon can improve patient care and prevent both unnecessary, extended medical evaluations and therapeutic trials.
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Affiliation(s)
- Varun Jain
- Neurology, University of Florida, Gainesville, USA
| | - William Remley
- Neurology, Lake Erie College of Osteopathic Medicine, Jacksonville, USA
| | - Arvind Mohan
- Neurosurgery, University of Florida, Gainesville, USA
| | - Emma L Leone
- Neurology, University of Florida, Gainesville, USA
| | - Srishti Taneja
- Neurology, Avalon University School of Medicine, Youngstown, USA
| | - Katharina Busl
- Neurocritical Care, University of Florida, Gainesville, USA
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Cao Y, Song X, Wang L, Qi Y, Chen Y, Xing Y. Transcranial Doppler Combined With Quantitative Electroencephalography Brain Function Monitoring for Estimating the Prognosis of Patients With Posterior Circulation Cerebral Infarction. Front Neurol 2021; 12:600985. [PMID: 34079507 PMCID: PMC8165540 DOI: 10.3389/fneur.2021.600985] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Accepted: 04/21/2021] [Indexed: 11/30/2022] Open
Abstract
Posterior circulation cerebral infarction (PCCI) can lead to deceased infratentorial cerebral blood flow (CBF) and metabolism. Neural activity is closely related to regional cerebral blood flow both spatially and temporally. Transcranial Doppler (TCD) combined with quantitative electroencephalography (QEEG) is a technique that evaluates neurovascular coupling and involves synergy between the metabolic and vascular systems. This study aimed to monitor brain function using TCD-QEEG and estimate the efficacy of TCD-QEEG for predicting the prognosis of patients with PCCI. We used a TCD-QEEG recording system to perform quantitative brain function monitoring; we recorded the related clinical variables simultaneously. The data were analyzed using a Cox proportional hazards regression model. Receiver-operating characteristic (ROC) curve analysis was used to evaluate the cut-off for the diastolic flow velocity (VD) and (delta + theta)/(alpha + beta) ratio (DTABR). The area under the ROC curve (AUROC) was calculated to assess the predictive validity of the study variables. Forty patients (aged 63.7 ± 9.9 years; 30 men) were assessed. Mortality at 90 days was 40%. The TCD indicators of VD [hazard ratio (HR) 0.168, confidence interval (CI) 0.047-0.597, p = 0.006] and QEEG indicators of DTABR (HR 12.527, CI 1.637-95.846, p = 0.015) were the independent predictors of the clinical outcomes. The AUROC after combination of VD and DTABR was 0.896 and showed better predictive accuracy than the Glasgow Coma Scale score (0.75), VD (0.76), and DTABR (0.781; all p < 0.05). TCD-QEEG provides a good understanding of the coupling mechanisms in the brain and can improve our ability to predict the prognosis of patients with PCCI.
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Affiliation(s)
- Yanting Cao
- Department of Vascular Ultrasonography, Xuanwu Hospital, Capital Medical University, Beijing, China
- Department of Neurology, The First Hospital of Jilin University, Changchun, China
- Department of Neurology, Linyi People’s Hospital, Linyi, China
| | - Xiaonan Song
- Department of Neurology, The First Hospital of Jilin University, Changchun, China
| | - Lijuan Wang
- Department of Neurology, The First Hospital of Jilin University, Changchun, China
| | - Yajie Qi
- Department of Neurology, The First Hospital of Jilin University, Changchun, China
| | - Ying Chen
- Department of Neurology, The First Hospital of Jilin University, Changchun, China
| | - Yingqi Xing
- Department of Vascular Ultrasonography, Xuanwu Hospital, Capital Medical University, Beijing, China
- Beijing Diagnostic Center of Vascular Ultrasound, Beijing, China
- Center of Vascular Ultrasonography, Beijing Institute of Brain Disorders, Collaborative Innovation Center for Brain Disorders, Capital Medical University, Beijing, China
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8
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Iorio-Morin C, Levesque M. Letter to the Editor. Spreading depolarizations in chronic subdural hematoma. J Neurosurg 2021; 134:1346-1347. [PMID: 32736360 DOI: 10.3171/2020.6.jns202185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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9
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Chegodaev D, Pavlova NV, Pavlova P, Lvova O. LPDs – «Linked to penumbra» discharges or EEG correlate of excitotoxicity: A review based hypothesis. Epilepsy Res 2020; 166:106429. [DOI: 10.1016/j.eplepsyres.2020.106429] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Revised: 07/05/2020] [Accepted: 07/13/2020] [Indexed: 12/12/2022]
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10
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Stroke after spontaneous intracranial hypotension: Not a single mechanism. Case report and review of literature. J Clin Neurosci 2020; 74:253-255. [PMID: 31948881 DOI: 10.1016/j.jocn.2020.01.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2019] [Accepted: 01/07/2020] [Indexed: 11/20/2022]
Abstract
Spontaneous intracranial hypotension (SIH) is a rare syndrome, typically manifests as orthostatic headache. Sometimes considered asbenignillness, neurological complications are well described, in particular subdural hematoma and cerebral venous sinus thrombosis. Brain infarction as complication of SIH is rarely reported. The main mechanism supported in the literature is the stretching of arteries due to the sagging of the brain. We report a case of SIH followed with brain infarction, with a distinct presentation from previous literature, suggesting a different mechanism. A 35 year-old had severe orthostatic headache, responsible for prolonged bed rest. One month later, he had acute left hemiparesis secondary to stroke and right posterior cerebral artery occlusion. Stroke MRI showed arguments for intracranial hypotension (thickened meninges). He was successfully treated with intravenous rtPA thrombolysis. Headache were resolved after an epidural blood patch. A patent foramen ovale was detected. Clinical features of this description were compared with previous literature. This case suggest a different mechanism for cerebral infarction after intracranial hypotension. In case of prolonged lying down due to intracranial hypotension, the presence of patent foramen ovale could be a risk factor for embolic stroke.
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Levesque M, Iorio-Morin C, Bocti C, Vézina C, Deacon C. Nonepileptic, Stereotypical, and Intermittent Symptoms (NESIS) in Patients With Subdural Hematoma: Proposal for a New Clinical Entity With Therapeutic and Prognostic Implications. Neurosurgery 2019; 87:96-103. [DOI: 10.1093/neuros/nyz355] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2019] [Accepted: 06/27/2019] [Indexed: 11/13/2022] Open
Abstract
Abstract
BACKGROUND
Transient neurological symptoms (TNS) are frequent in patients with subdural hematomas (SDH) and many will receive a diagnosis of epilepsy despite a negative workup.
OBJECTIVE
To explore if patients with TNS and a negative epilepsy workup (cases) evolved differently than those with a positive EEG (controls), which would suggest the existence of alternative etiologies for TNS.
METHODS
We performed a single-center, retrospective, case-control study of patients with TNS post-SDH. The demographics and clinical and semiological features of cases and controls were compared. The outcome and response to antiepileptic drugs were also assessed and a scoring system developed to predict negative EEG.
RESULTS
Fifty-nine patients with SDH-associated TNS were included (39 cases and 20 controls). Demographic characteristics were comparable in both groups. Dysphasia and prolonged episodes were associated with a negative EEG. Clonic movements, impaired awareness, positive symptomatology, complete response to antiepileptic drugs, and mortality were associated with a positive EEG. Using semiological variables, we created a scoring system with a 96.6% sensitivity and 100% specificity in predicting case group patients. The differences observed between both groups support the existence of an alternative etiology to seizures in our case group. We propose the term NESIS (NonEpileptic, Stereotypical, and Intermittent Symptoms) to refer to this subgroup and hypothesize that TNS in these patients might result from cortical spreading depolarization.
CONCLUSION
We describe NESIS as a syndrome experienced by SDH patients with specific prognostic and therapeutic implications. Independent validation of this new entity is now required.
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Affiliation(s)
- Mathieu Levesque
- Division of Neurology, Department of Medicine, Université de Sherbrooke, Centre de Recherche du Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, Canada
| | - Christian Iorio-Morin
- Division of Neurosurgery, Department of Surgery, Université de Sherbrooke, Centre de Recherche du Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, Canada
| | - Christian Bocti
- Division of Neurology, Department of Medicine, Université de Sherbrooke, Centre de Recherche du Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, Canada
| | - Caroline Vézina
- Division of Family Medicine, Department of Family Medicine, Université de Sherbrooke, Centre de Recherche du Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, Canada
| | - Charles Deacon
- Division of Neurology, Department of Medicine, Université de Sherbrooke, Centre de Recherche du Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, Canada
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12
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Blood Flow and Continuous EEG Changes during Symptomatic Plateau Waves. Brain Sci 2018; 8:brainsci8010014. [PMID: 29329250 PMCID: PMC5789345 DOI: 10.3390/brainsci8010014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2017] [Revised: 01/03/2018] [Accepted: 01/08/2018] [Indexed: 11/16/2022] Open
Abstract
Benign meningiomas uncommonly lead to significant cerebral edema, with only a few cases previously reported in the medical literature. The present study describes the case of a 49-year-old female who had a meningioma resection. She subsequently developed malignant cerebral edema and had episodes that were initially concerning for seizure activity. However, transient blood flow changes concerning for intracranial pressure (ICP) crises, were demonstrated on electroencephalogram (EEG) as well as noninvasive cerebral blood flow monitoring. The present case highlights the importance of close monitoring in patients with post meningioma resection cerebral edema because of the possibility of ICP crises.
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Zhao T, Fu Y, Sun H, Liu X. Ligustrazine suppresses neuron apoptosis via the Bax/Bcl-2 and caspase-3 pathway in PC12 cells and in rats with vascular dementia. IUBMB Life 2017; 70:60-70. [PMID: 29247598 DOI: 10.1002/iub.1704] [Citation(s) in RCA: 88] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2017] [Revised: 11/14/2017] [Accepted: 11/20/2017] [Indexed: 11/06/2022]
Abstract
The aim of this study was to examine the comprehensive neuroprotective mechanism of ligustrazine, which is extracted from Ligusticum Chuanxiong Hort., against vascular dementia (VD) in rats and apoptosis in oxygen and glucose deprivation (OGD) PC12 cells. Rats were subjected to bilateral common carotid artery occlusion (BCCAO) surgery and administered ligustrazine intragastrically for 6 weeks. At the end of the experiments, the hippocampal biomarkers brain-derived neurotrophic factor (BDNF), monocyte chemotactic protein 1 (MCP-1), and homocysteine (Hcy) were examined. In experiments in vitro, OGD PC12 cells were treated with ligustrazine for 0.5, 1, 3, 6, 12, or 24 h. The cell-released biomarkers BDNF, MCP-1, and Hcy were examined. Microscopy, acridine orange-ethidium bromide (AO/EB) staining, and flow cytometry assays were performed to investigate apoptosis. Cleaved caspase-3, Bcl-2 associated X protein (Bax), and B cell lymphoma 2 (Bcl-2) expression was examined using Western blot assays. The results showed that biomarkers, including MCP-1 and Hcy, were significantly increased in both the in vivo and in vitro models, while the BDNF level was significantly decreased compared with the sham or vehicle models. Microscopy, AO/EB staining, and flow cytometry analysis showed that severe cell damage occurred in OGD PC12 cells, and apoptosis played a major role in this environment. Further Western blot studies showed that the apoptosis-related Bax/Bcl-2 protein ratio and cleaved caspase-3 were significantly increased in the experiment. However, ligustrazine profoundly suppressed the imbalance of these biomarkers, reduced cell damage, decreased the Bax/Bcl-2, and downregulated cleaved caspase-3. Pro- and anti-apoptotic biomarkers of multiple pathways including BDNF, MCP-1, and Hcy played a joint role in triggering the activation of the mitochondria-related Bax/Bcl-2 and caspase-3 apoptosis pathway in VD. Ligustrazine attenuated VD by comprehensively regulating BDNF, MCP-1, and Hcy and inactivating the Bax/Bcl-2 and caspase-3 apoptosis pathway. Our data provide novel insight into ligustrazine, which is a promising neuroprotective agent for VD disease treatment strategies. © IUBMB Life, 70(1):60-70, 2018.
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Affiliation(s)
- Tengfei Zhao
- Center of Drug Metabolism and Pharmacokinetics, China Pharmaceutical University, Nanjing, China
| | - Yingxue Fu
- School of Pharmacy, Nanjing University of Chinese Medicine, Nanjing, China.,Key Laboratory of Efficacy and Safety Evaluation of Traditional Chinese Medicine in Jiangsu Province, Nanjing, China
| | - Hao Sun
- School of Pharmacy, Nanjing University of Chinese Medicine, Nanjing, China.,Key Laboratory of Efficacy and Safety Evaluation of Traditional Chinese Medicine in Jiangsu Province, Nanjing, China
| | - Xiaoquan Liu
- Center of Drug Metabolism and Pharmacokinetics, China Pharmaceutical University, Nanjing, China
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