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Diseases of the Nervous System
Published in George Feuer, Felix A. de la Iglesia, Molecular Biochemistry of Human Disease, 2020
George Feuer, Felix A. de la Iglesia
Many disorders of the nervous system originate from metabolic or nutritional disorders,193,196,276,287,358 related to anoxia or hypoglycemia,132,170,202,239,402,532,548 or deficiency of some essential factors,167,180,196 or have a genetic origin, such as inborn errors of metabolism. The clinical manifestation and progress of these conditions may be significantly more complicated and catastrophic as compared to other tissues or organs.138 Some neurologic disorders are secondary to hepatic, renal, endocrine systemic disease, tumors, and infections.18,23,25,34,60,100,203,254,308,336,424 Biochemical and physiological mechanisms underlying cerebrovascular disorders, ischemic vascular disease, or intracranial hemorrhage are similar to cardiovascular events and basic changes occuring during the development of atherosclerosis. Some disorders are, however, more pronounced. The effects of infectious diseases on the central nervous system, such as pyogenic bacteria, fungal infections, or viral diseases, show variations187 and can be more intense and deteriorating as compared to their actions on other organs. There are several special disorders, such as degenerative and demyelinating diseases, which are specific to the nervous system. Cerebral lesions have general deleterious effects on many neurologic and mental faculties irrespective of their location and depending in part upon their extent.164,309
Animal models of vascular dementia with emphasis on stroke-prone spontaneously hypertensive rats
Published in H. Saito, Y. Yamori, M. Minami, S.H. Parvez, New Advances in SHR Research –, 2020
Hideya Saito, Hiroko Togashi, Mitsuhiro Yoshioka, Nishio Nakamura, Masaru Minami, Hasan S. Parvez
Three experimental models designed to reflect different aspects of vascular dementia have been evaluated. Two experimental models (rats with cerebrovascular occlusion and rats with cerebral embolization) have been critically reviewed. The present study focused on the stroke-prone spontaneously hypertensive rat (SHRSP) as a model for vascular dementia. Neuropathological data revealed that the cerebrovascular disorder in SHRSP was associated with lesions in their brains similar to those seen in typical human case of multiple cerebral infarction. In addition, those SHRSP that died from cerebral infarction exhibited behavioral changes, including increased activity and disrupted Orcadian rhythms, which might correspond to the state of delirium observed in patients with dementia. SHRSP displayed cognitive impairments in a step-through passive avoidance task. When compared to age-matched WKY, both conscious and anesthetized SHRSP had significantly decreased cerebral spinal fluid (CSF) levels of acetylcholine (ACh). These findings suggest that the SHRSP might serve as a suitable animal model for vascular dementia in humans caused by cerebrovascular lesions.
Neurosurgery: Cerebrovascular diseases
Published in Hemanshu Prabhakar, Charu Mahajan, Indu Kapoor, Essentials of Geriatric Neuroanesthesia, 2019
Paolo Gritti, Luigi Andrea Lanterna, Francesco Ferri, Carlo Brembilla, Ferdinando Luca Lorini
Many individual factors can contribute to CVD and stroke in general. Independent stroke predictors include age, systolic blood pressure (BP), hypertension, diabetes mellitus, current smoking, established cardiovascular disease such as myocardial infarction, angina, or coronary insufficiency, congestive heart failure, intermittent claudication, atrial fibrillation, and left ventricular hypertrophy on ECG (5,6). Other potential risk factors include obesity, BP variability, sleep-disordered breathing, chronic inflammation, chronic kidney disease, migraine, hormonal contraception or hormone replacement therapy, psychosocial stress, depression, job strain, and long working hours (7,8). However, among these risk factors, hypertension, smoking, and diabetes are certainly the most important factors leading to CVDs, as they can change the structure of blood vessels and result in atherosclerosis (5,6). These risk factors manifest their effects over time, and as a consequence, CVDs are widespread among the elderly population. In fact, the cumulative effects of aging on the cardiovascular system and the progressive nature of stroke risk factors over a prolonged period substantially increase the risk of ischemic stroke (IS) and intracerebral hemorrhage (ICH) (6). It seems evident that age is the most common and strongest risk factor among cerebrovascular disorders and subclinical cerebral diseases (3–6).
Late-onset neuromyelitis optica spectrum disorder mimicking stroke in an elderly Chinese man: Case report
Published in The Journal of Spinal Cord Medicine, 2022
Lei Li, Gao-Li Fang, Yang Zheng, Yin-Xi Zhang
The acute-onset, lateralizing neurological deficits and an old age were all indicative of cerebrovascular disorders as a potential diagnosis. However, the development of weakness in the contralateral extremities with urinary incontinence raised the concern of an alternative etiology. Detection of longitudinal extensive cervical cord lesions on T2-weighted images further supported the diagnosis of acute myelitis rather than stroke. According to the international consensus diagnostic criteria, the diagnosis of NMOSD is mainly based on the positive AQP4 antibody and the presence of at least one of the core clinical characteristics associated with optic nerve, spinal cord, area postrema, other brainstem, diencephalic, or cerebral presentations.3 The positive serum AQP4 antibody in this patient further pointed to a definite diagnosis of NMOSD.
Screening for cerebrovascular disorder on the basis of family history in asymptomatic children
Published in British Journal of Neurosurgery, 2021
Christopher Paul Millward, Libby Van Tonder, Dawn Williams, Owen Thornton, Mitchell Foster, Michael Griffiths, Mani Puthuran, Arun Chandran, Anil Israni, Ajay Sinha, Rachel Kneen, Conor Mallucci
Cerebrovascular disorders in children constitute a broad group of relatively rare and distinct pathologies, and represent one of the top ten causes of mortality in patients aged 5–24 years.1 Although uncommon, stroke in children (from all causes) over one month of age has an estimated incidence of 13 per 100,000 children.2 Due to the heterogeneity of cerebrovascular conditions, the risk of having a cerebrovascular condition based on genetic inheritance with a positive family history, is difficult to determine. Congenital paediatric cerebrovascular diseases are very rare, with estimates of only three cases per 100,000 per year.3 The rarity and heterogenous nature of cerebrovascular disease in children therefore requires expertise and experience to guide their management. Some guidelines do exist to inform aspects of paediatric cerebrovascular disease management, but are essentially restricted to stroke in children,4 and screening in families with Hereditary haemorrhagic telangiectasia (HHT).5 The majority of care decisions are therefore based on expert opinion, and extrapolation of evidence from literature pertaining to adult cohorts, for instance regarding the screening for intracranial aneurysms (IC) in asymptomatic members of families with two or more affected first-degree relatives.6 There are no general guidelines to inform screening practice in asymptomatic children with similarly affected first-degree family members, for either IC or non-HHT AVM.
Use of 18F-Fluorodeoxyglucose–Positron Emission Tomography/Computed Tomography to successfully diagnose central nervous system vasculitis in systemic lupus erythematosus and antiphospholipid syndrome: a case report
Published in Modern Rheumatology Case Reports, 2021
Koji Mishima, Masahiro Ayano, Tomoya Nishida, Tomofumi Tatsutani, Shoichiro Inokuchi, Yasutaka Kimoto, Hiroki Mitoma, Mitsuteru Akahoshi, Yojiro Arinobu, Koichi Akashi, Takahiko Horiuchi, Hiroaki Niiro
Although it is considered rare for vasculitis to cause cerebrovascular disorders, multiple reports have demonstrated the effectiveness of immunosuppression in treating these disorders [41–43], suggesting that, contrary to previous thought, vasculitis can be involved in their development. Bleeding sites in SLE patients differ from those commonly seen in the general population [4,44], and this difference also indicates the involvement of other pathologies, such as vasculitis. As small blood vessels are considered to be affected in SLE-associated CNS vasculitis [9,45], and MRI and angiography may fail to confirm clinically suspected vasculitis, FDG-PET may be useful in such patients. Additionally, FDG-PET is a useful means of investigating and diagnosing CNS vasculitis in that, unlike spinal fluid IL-6 measurement, it can also uncover the anatomical location of vasculitis. FDG-PET is expensive, and its indications need to be carefully selected. In addition to the aforementioned patients, this imaging modality may be indicated for the following patients: patients who are middle-aged or older with cardiovascular disease risk factors and are clinically suspected of inflammatory conditions; young patients with a cerebrovascular disorder of unknown aetiology; patients in whom it is unclear whether the cause of the cerebrovascular disorder is embolic or inflammatory; patients scheduled for brain biopsy whose biopsy site is difficult to be determined by other imaging modalities, such as MRI; and patients for whom spinal fluid investigations are contraindicated or difficult to perform.