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Diagnosis of Alzheimer Disease
Published in Robert E. Becker, Ezio Giacobini, Alzheimer Disease, 2020
J.P. Blass, R.S. Black, K.A. Nolan, A. Kurita
Brain biopsy is a highly invasive technique which has not seen wide-spread use (Martin et al, 1987). It is, however, relatively safe and is available if circumstances were to warrant: for instance, if a treatment became available which appeared effective but had potential side effects more serious than those of brain biopsy.
Herpes Simplex Encephalitis and Other Neurological Syndromes Caused by Herpes Simplex Virus-1
Published in Marie Studahl, Paola Cinque, Tomas Bergström, Herpes Simplex Viruses, 2017
Marie Studahl, Birgit Sköldenberg
The need for brain biopsy in HSE diagnostics has substantially been reduced as a result of the introduction of the less invasive PCR technique. Brain biopsy is associated with complication risks in approximately 3% (30). Still, there are clinical circumstances where diagnostic uncertainty remains. A brain biopsy remains an option to be considered if no alternative noninvasive method can be used to determine whether a patient is suffering from a potentially treatable disease. Sensitivity and specificity depend on the neurosurgical technique and the biopsy site chosen (147,148). When brain biopsy is performed, routine histology and specific staining for viral inclu- sions, fungi, bacteria, and mycobacteria should be undertaken as well as viral DNA/RNA PCR analyses, virus isolations, fungal, bacterial, and mycobac- terial cultures. It is important that the biopsy is taken from the affected regions, i.e., usually the temporal lobes, and stereotactic techniques should be used.
Lesion Surgery for Parkinson's Disease: Practical Aspects of New Developments
Published in Lucien Côté, Lola L. Sprinzeles, Robin Elliott, Austin H. Kutscher, Parkinson's Disease and Quality of Life, 2014
Thalamotomies and pallidotomies are procedures that last from 1 to more than 8 hours, depending on the exact approach utilized. The patients remain awake and interactive throughout the procedure. At times, patients may be given sedation to help them tolerate certain uncomfortable portions of the operation. A stereotactic frame is secured to the head, imaging studies are obtained, and then the patient is brought to the operating room. In the operating room, a small area on the top of the head is shaved, a local anesthetic injected, a small incision is made and a small hole in the skull is created. Then, the stereotactic device allows guidance of electrodes to the desired targets. Recording studies, stimulation studies, and then, lesioning is carried out, much of which requires interaction with the patient. Improvement of the patient's condition is usually seen immediately upon creation of the lesion. The entire procedure is generally no more uncomfortable than a common dental procedure or a stereotactic brain biopsy, a relatively common brain operation.
Technical note: the use of frameless stereotactic guidance in the treatment of peripheral intracranial aneurysms
Published in British Journal of Neurosurgery, 2023
Leslie A. Nussbaum, Kevin M. Kallmes, Eric S. Nussbaum
A prospective, randomized, single center study of 53 patients undergoing brain biopsy showed that while mean operating time was shorter (but not significantly) in the frameless group (47 ± 26 min vs. 59 ± 26 min; p = 0.140), the overall procedure time was significantly shorter in the frameless group (59 ± 31 min vs. 84 ± 27 min; p = 0.003).10 This is in agreement with a large retrospective study of 465 total patients, in which the frameless group had shorter operating time compared to the frame-based series (127 ± 33 minutes vs. 149 ± 32 min; p < 0.001).11 In contrast, one study did report that frameless biopsies required a higher total operating time compared to frame-based systems (185 ± 6 min vs. 114 ± 3 min; p = 0.003), due to increased anaesthesia resources and longer operating room time.12
Tumefactive demyelination: updated perspectives on diagnosis and management
Published in Expert Review of Neurotherapeutics, 2021
Pedro Sánchez, Fiona Chan, Todd A. Hardy
The finding of a tumefactive lesion on MRI need not always be worrying for the clinician. A number of diagnostic clues are available with careful interpretation of MR imaging and serological testing combined with CSF examination and PET scanning. Indeed, these investigations can obviate the need for brain biopsy except in the most atypical cases. Acute treatment of TD involves corticosteroids and/or PLEX, and longer-term treatment options depend on whether an underlying disease process such as MS, NMOSD or other atypical forms of CNS demyelinating disease can be made. In the absence of randomized clinical trials for how to approach TDLs which occur outside of established disease states, the astute clinician will benefit from shared decision making with their patient about how to navigate difficult treatment decisions and from facilitating close follow-up of patients.
Granulomatous amoebic encephalitis caused by Acanthamoeba in a patient with AIDS: a challenging diagnosis
Published in Acta Clinica Belgica, 2021
Hsien Lee Lau, Daniela F. De Lima Corvino, Francisco M. Guerra, Amer M. Malik, Paola N. Lichtenberger, Sakir H. Gultekin, Jana M. Ritter, Shantanu Roy, Ibne Karim M. Ali, Jennifer R. Cope, M. Judith D. Post, Jose A. Gonzales Zamora
In GAE, brain biopsy with immunohistochemistry and PCR studies are the gold standard diagnostic tools and both are available at the CDC [10]. Acanthamoeba spp. can be visualized with common stains (e.g. trichrome, hematoxylin and eosin (H&E)) and immunohistochemistry stains in brain tissue [7]. Unfortunately sectioning of the brain tissue while the patient was admitted at our institution did not reveal amoeba but showed non-specific granulomatous inflammation and necrosis. We did not see any monoclonal B or T cell infiltration, making malignancy unlikely. At that point, it was unclear whether this was an atypical presentation of a common disease, such as central nervous system lymphoma or tuberculosis, vs a rare disease. Due to this inconclusive work-up and the patient’s clinical improvement despite the lack of definitive treatment, he was discharged without a clear diagnosis from his first hospital admission. In retrospect, we believe that a second brain biopsy and an early neuropathology evaluation of tissue specimens by an advanced institution should have been pursued before discharge. It was only until his second hospital admission that the brain tissue was sent to the CDC, where additional sectioning of the specimen was performed. This led to identification of amoebas in H&E-stained sections and immunohistochemistry. Unfortunately, the final diagnosis was achieved after the patient’s death.