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Infectious Optic Neuropathies
Published in Vivek Lal, A Clinical Approach to Neuro-Ophthalmic Disorders, 2023
Imran Rizvi, Ravindra Kumar Garg
Ophthalmological manifestations are common in syphilis. Common eye complications are scleritis, panuveitis, dacyroadenitis, chorioretinitis, vitritis, keratitis, oculomotor palsies and optic neuropathy.33 Ocular involvement is generally part of central nervous system involvement. The optic nerve in syphilis is involved in secondary or tertiary stages.2 The syphilitic optic neuropathy can be unilateral or bilateral, often without involvement of the anterior segment.2 Syphilitic optic neuropathy presents either as papillitis, chiasmal syndrome, neuroretinitis, optic nerve gumma or optic nerve perineuritis.34–36 There can also be cortical vision loss. Appropriate tests for the diagnosis of ocular syphilis are fluorescent treponemal antibody absorption assay or the Treponema pallidum particle agglutination assay. The non-treponemal tests, like venereal disease research laboratory (VDRL), fail to diagnose late stages of syphilis.37 Intravenous penicillin G is the drug of choice for all forms of syphilis. Intramuscular benzathine penicillin along with oral probenecid is another option. Newer treatment options include drugs with good cerebrospinal fluid penetration, like ceftriaxone and azithromycin.38
Specialized Circulations in Susceptible Tissues
Published in Wilmer W Nichols, Michael F O'Rourke, Elazer R Edelman, Charalambos Vlachopoulos, McDonald's Blood Flow in Arteries, 2022
The carotid arteries transmit some 75 percent of blood needed by the brain into the cranium. Most of the rest comes from the vertebral arteries on each side, which ascend through the transverse processes of cervical vertebrae, then enter the dural sac, pass through the foramen magnum into the cranium where they join to form the basilar artery, which links with branches of the carotid artery to form the Circle of Willis and connects all arteries that enter the skull to supply the brain, brainstem and upper part of the spinal cord. Venous blood collects in the venous sinuses before exiting the cranium through the right and left jugular veins into the neck. Approximately one liter of blood runs through this path every minute. Other spinal arteries enter the spinal canal with the nerves that join the rest of the spinal cord in the canal; the spinal canal ends at the level of the lowest lumbar vertebra. The spinal cord connects with the brain at the foramen magnum. Cerebrospinal fluid bathes the brain and spinal cord in the subarachnoid space of the cranium and spinal cord. The cerebral arteries and veins in the cranium run in the subarachnoid space. The veins have no valves. Valves are not needed for blood to leave the normal skull.
Neurology
Published in Faye Hill, Sash Noor, Neel Sharma, Tiago Villanueva, Medical and Surgical Emergencies for Students and Junior Doctors, 2021
Faye Hill, Sash Noor, Neel Sharma
Routine blood investigations are essential and include a full blood count, urea and electrolytes and C-reactive protein. Cerebrospinal fluid analysis is key in determining a diagnosis. Cerebrospinal fluid findings include the presence of mononuclear cells with a normal or elevated protein and reduction in glucose. Cerebrospinal fluid should be sent for a polymerase chain reaction test for enteroviruses and herpes virus. Prior to a lumbar puncture, patients should, of course, undergo a CT or MRI head.
Decline of stress resilience in aging rats: Focus on choroid plexus-cerebrospinal fluid-hippocampus
Published in The World Journal of Biological Psychiatry, 2023
Kaige Liu, Huizhen Li, Ningxi Zeng, Wenjun Lu, Xiaofeng Wu, Hanfang Xu, Can Yan, Lili Wu
Choroid plexus (CP), a highly vascularised tissue, is the major site of cerebrospinal fluid (CSF) production. Stress and ageing can both result in morphologic changes in CP, including volume reduction, cellular atrophy, microvilli shortening, thickening of the basement membrane, and so on (Kaur et al. 2016; Kratzer et al. 2020). Low expression of receptors and transporters on CP may induce transport dysregulation, and thus affect CSF constituents (Wu et al. 2020). During normal ageing, CSF exhibits reduced production and increased circulation resistance, with downregulated neurotrophins (Lugert et al. 2017). Physiologically, hippocampus is adjacent to the lateral ventricles. CSF composition can act directly on hippocampus, proceeding to changes in hippocampal structure and function, such as regulating neurogenesis, neuronal survival, and synaptic plasticity (Ziegler et al. 2015).
Dural venous sinus stenting in patients with idiopathic intracranial hypertension: report of outcomes from a single-center prospective database and literature review
Published in Expert Review of Ophthalmology, 2022
Matthew J Kole, Juan Carlos Martinez-Gutierrez, Francisio Sanchez, Rosa Tang, Peng Roc Chen
Cerebrospinal fluid (CSF) is produced in the choroid plexus within the ventricles of the brain at a steady rate. After circulating the subarachnoid space, it is then cleared by reabsorption through arachnoid granulations into the venous sinuses [8]. Although the precise mechanistic underpinnings of IIH are not known, an overabundance of CSF is believed to be a cause of increased intracranial pressure. It is unclear if IIH arises from an enhanced production or poor clearance of CSF but its removal results in resolution of IIH [9]. Given the role of the cerebral venous sinuses in CSF clearance, it is possible that their disruption can contribute to IIH. Cerebral venous sinus stenosis (VSS) is observed in 93% of patients with IIH [10]. However, debate about the order in which VSS and IIH appear remains. Illustrative cases have demonstrated that after CSF diversion, VSS can resolve, pointing to VSS being a secondary event from intracranial pressure external compression [11]. Others have demonstrated persistence of VSS despite CSF diversion pointing toward VSS being the primary etiology [12]. The final common pathway of either of the proposed mechanisms could result in a feed-forward loop of elevated intracranial pressure causing venous sinus compression, which in turn causes a further increase in intracranial pressure. As we discuss in the following sections, mounting evidence exists for enhancing CSF clearance by VSS stenting normalizing intracranial pressure.
De Novo Vogt-Koyanagi-Harada Disease following Covid-19 Vaccine: A Case Report and Literature Overview
Published in Ocular Immunology and Inflammation, 2022
Jean-Baptiste Brunet de Courssou, Mylène Tisseyre, Jérôme Hadjadj, Laurent Chouchana, Florent Broca, Benjamin Terrier, Pierre Duraffour, Soledad Henriquez
Cerebrospinal fluid analysis revealed an aseptic meningitis. In details, proteins levels were of 0.28 g/L, white blood cells count 110/µL – of which 99% lymphocytes – and red blood cells 1/µL with a normal glycorrhachia. There was no integumentary change nor cochleo-vestibular impairment. Other physical examination, standard blood analysis and brain MRI were normal – namely ruling out demyelination. Of note, C-reactive protein was elevated at 14 mg/L. There was no evidence for syphilis infection, Behçet’s disease nor sarcoidosis. Antinuclear antibodies were not searched. The audiogram was in favor of an age-related sensorineural hearing loss. A diagnosis of incomplete VKH disease was made, as there was no integumentary findings.2 Choroidal thickening, due to local inflammation, associated with choroidal folds are highly suggestive of this disease.3