终板造瘘对动脉瘤性蛛网膜下腔出血后慢性脑积水的影响

目的:探讨终板造瘘对动脉瘤性蛛网膜下腔出血后慢性脑积水的影响。方法:回顾性分析201例动脉瘤性蛛网膜下腔出血患者的临床资料,将所有患者按动脉瘤夹闭术中是否进行终板造瘘分为两组,随访6个月以上,评价其慢性脑积水的发生率。结果:所有患者慢性脑积水的总发生率为17.4%,终板造瘘组慢性脑积水的发生率7.8%,而单独夹闭组慢性脑积水的发生率为28.1%,显著高于终板造瘘组(P0.05)。在FisherⅠ-Ⅱ级中,终板造瘘组与单独夹闭组慢性脑积水的发生率分别为5.0%、7.7%,两组比较无统计学差异(P0.05);FisherⅢ-Ⅳ级中,终板造瘘组与单独夹闭组慢性脑积水的发生率分别为10.8%、40.3%,单独夹闭组显著高于终板造瘘组(P0.05);而Hunt-HessⅠ-Ⅱ级中,终板造瘘组与单独夹闭组慢性脑积水的发生率分别为7.0%、9.4%,两组比较无统计学差异(P0.05),Hunt-HessⅢ-Ⅳ级中终板造瘘与单独夹闭组慢性脑积水的发生率分别为11.3%、46.5%,单独夹闭组显著高于终板造瘘组(P0.05)。结论:终板造瘘可明显降低Hunt-HessⅢ-Ⅳ级、FisherⅢ、Ⅳ级动脉瘤性蛛网膜下腔出血后患者慢性脑积水的发生率,而对Hunt-HessⅠ-Ⅱ级、FisherⅠ-Ⅱ级的动脉瘤性蛛网膜下腔出血后患者慢性脑积水的发生率影响不明显。     

Spontaneous intracranial hypotension is diagnosed by a combination of lipocalin-type prostaglandin D synthase and brain-type transferrin in cerebrospinal fluid

Background

Spontaneous intracranial hypotension (SIH) is caused by cerebrospinal fluid (CSF) leakage. Definitive diagnosis can be difficult by clinical examinations and imaging studies.

Brain development in mice lacking L1-L1 homophilic adhesion

A new mouse line has been produced in which the sixth Ig domain of the L1 cell adhesion molecule has been deleted. Despite the rather large deletion, L1 expression is preserved at normal levels. In vitro experiments showed that L1-L1 homophilic binding was lost, along with L1-alpha5beta1 integrin binding. However, L1-neurocan and L1-neuropilin binding were preserved and sema3a responses were intact. Surprisingly, many of the axon guidance defects present in the L1 knockout mice, such as abnormal corticospinal tract and corpus callosum, were not observed. Nonetheless, when backcrossed on the C57BL/6 strain, a severe hydrocephalus was observed and after several generations, became an embryonic lethal. These results imply that L1 binding to L1, TAG-1, or F3, and L1-alpha5beta1 integrin binding are not essential for normal development of a variety of axon pathways, and suggest that L1-L1 homophilic binding is important in the production of X-linked hydrocephalus.     

The effect of ventricular volume increase in the amplitude of intracranial pressure

We study the impact of vascular pulse in the cerebrospinal fluid (CSF) pressure measured on the lateral cerebral ventricles, as well as its sensitivity with respect to ventricular volume change. Recent studies have addressed the importance of the compliance capacity in the brain and its relation to arterial pulse abortion in communicating hydrocephalus. Nevertheless, this mechanism is not fully understood. We propose a fluid-structure interaction (FSI) model on a 3?D idealized geometry based on realistic physiological and morphological parameters. The computational model describes the pulsatile deformation of the third ventricle due to arterial pulse and the resulting CSF dynamics inside brain pathways. The results show that when the volume of lateral ventricles increases up to 3.5 times, the amplitudes of both average and maximum pressure values, computed on the lateral ventricles surface, substantially decrease. This indicates that the lateral ventricles expansion leads to a dumping effect on the pressure exerted on the walls of the ventricles. These results strengthen the possibility that communicant hydrocephalus may, in fact, be a natural response to reduce abnormal high intracranial pressure (ICP) amplitude. This conclusion is in accordance with recent hypotheses suggesting that communicant hydrocephalus is related to a disequilibrium in brain compliance capacity.     

Neuroembryopathic effect of trichloroacetic acid in rats exposed during organogenesis

BACKGROUND: Halogenated hydrocarbons such as trichloroacetic acid (TCA) are among the most common water supply contaminants in the world. This study examines the effect of TCA on the developing brain of the Charles Foster rat. METHODS: Adult pregnant rats were placed in the test group and exposed to various concentration of TCA (i.e., 1000, 1200, 1400, 1600, and 1800 mg/kg body weight [b.w.]) by oral gavage throughout the period of organogenesis from Gestation Day (GD) 6-15 of gestation. Trichloroacetic acid was administered in the form of trichloroacetate, which is reduced to TCA in the body. The control mother rats were administered an equal volume of distilled water. Fetal brains were examined for their external and histological malformation. RESULTS: On GD 19, TCA administration led to an initial increase of brain weight at 1000 mg/kg b.w. and then a weight reduction after TCA doses of 1200 mg/kg b.w. and over. The brain of the formalin-fixed fetuses at 1000 and 1200 mg/kg b.w. showed hydrocephalus with breech of the ependymal lining, altered choroids plexus architecture, and increased apoptosis. At doses of 1400 mg/kg b.w. and above, the brain showed not only enhanced apoptosis of the neuronal cells, but extravasation of erythrocytes within the cortical parenchyma, vacuolation of the neuropil, and multiple cavity formation. CONCLUSION: With an increase in dose of TCA i.e., 1200 mg/kg b.w. and above, there is enhanced apoptosis, leading to increased neuronal death, which consequently led to the reduction in the brain weight as compared to controls. The fetal central nervous system is susceptible to the toxic effect of TCA.     

Adverse event following live attenuated chikungunya vaccine in a cynomolgus macaque with pre‐existing chronic hydrocephalus

A cynomolgus macaque (Macaca fascicularis) with a pre‐existing, undiagnosed, subclinical but severe cerebral hydrocephalus was enrolled in a study of long‐term immunogenicity of the IRES/CHIK vaccine. The animal began showing signs of neurological dysfunction post‐vaccination, which progressed and ultimately resulted in euthanasia. The underlying brain abnormality was revealed at necropsy and was subsequently investigated with gross and microscopic examination. This becomes the first reported case of an adverse event following administration of a live attenuated vaccine and suggests the possibility of an increased susceptibility risk of unwanted adverse outcome associated with vaccination in populations with pre‐existing conditions such as hydrocephalus.     

A mathematical model of blood,cerebrospinal fluid and brain dynamics

Using first principles of fluid and solid mechanics a comprehensive model of human intracranial dynamics is proposed. Blood, cerebrospinal fluid (CSF) and brain parenchyma as well as the spinal canal are included. The compartmental model predicts intracranial pressure gradients, blood and CSF flows and displacements in normal and pathological conditions like communicating hydrocephalus. The system of differential equations of first principles conservation balances is discretized and solved numerically. Fluid–solid interactions of the brain parenchyma with cerebral blood and CSF are calculated. The model provides the transitions from normal dynamics to the diseased state during the onset of communicating hydrocephalus. Predicted results were compared with physiological data from Cine phase-contrast magnetic resonance imaging to verify the dynamic model. Bolus injections into the CSF are simulated in the model and found to agree with clinical measurements.

---