Neuropathological Features of Covid-19 Solomon, Isaac H; Normandin, Erica; Bhattacharyya, Shamik ...
The New England journal of medicine,
09/2020, Letnik:
383, Številka:
10
Journal Article
Recenzirano
Odprti dostop
Eighteen brains of patients who died 0 to 32 days after the onset of symptoms of SARS-CoV-2 infection showed hypoxic–ischemic changes but no encephalitis, meningitis, strokes, or changes in olfactory ...bulbs or tracts. Low viral counts were detected by quantitative RT-PCR in a few brain sections, and no virus was evident on immunohistochemical analysis.
The availability of vaccines against the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), provides hope towards mitigation of the coronavirus disease 2019 (COVID-19) pandemic. Vaccine ...safety and efficacy has not been established in individuals with chronic autoimmune diseases such as multiple sclerosis (MS). Anecdotal reports suggest that the vaccines may be associated with brain, spinal cord, peripheral nervous system, and cardiac inflammation. Based on the high morbidity and unpredictable course of COVID-19, and the need to achieve herd immunity, vaccination has been recommended for patients with MS. We report clinical and MRI features of seven individuals who received the Moderna (
n =
3) or Pfizer (
n =
4) SARS-CoV-2 mRNA vaccines. Within one to 21 days of either the first (
n =
2) or second (
n =
5) vaccine dose, these patients developed neurologic symptoms and MRI findings consistent with active CNS demyelination of the optic nerve, brain, and/or spinal cord. Symptoms included visual loss, dysmetria, gait instability, paresthesias, sphincter disturbance, and limb weakness. Age ranged from 24 to 64 (mean 39.1) years; five were woman (71.4%). The final diagnosis was exacerbation of known stable MS (
n =
4, two were receiving disease-modifying therapy at the time of vaccination), new onset MS (
n =
2), or new onset neuromyelitis optica (
n =
1). All responded to corticosteroid (
n =
7) or plasma exchange (
n =
1) therapy, with five returning to baseline and two approaching baseline. Large prospective studies are required to further investigate any possible relationship between COVID-19 vaccines and acute CNS demyelination.
Is the cerebrum involved in its own activation to states of attention or arousal? “Telencephalon” is a term borrowed from embryology to identify not only the cerebral hemispheres of the forebrain, ...but also the basal forebrain. We review a generally undercited literature that describes nucleus basalis of Meynert, located within the substantia innominata of the ventrobasal forebrain, as a telencephalic extension of the ascending reticular activating formation. Although that formation’s precise anatomical definition and localization have proven elusive over more than 70 years, a careful reading of sources reveals that there are histological features common to certain brainstem neurons and those of the nucleus basalis, and that a largely common dendritic architecture may be a morphological aspect that helps to define non-telencephalic structures of the ascending reticular activating formation (e.g., in brainstem) as well as those parts of the formation that are telencephalic and themselves responsible for cortical activation. We draw attention to a pattern of dendritic arborization described as “isodendritic,” a uniform (isos-) branching in which distal dendrite branches are significantly longer than proximal ones. Isodendritic neurons also differ from other morphological types based on their heterogeneous, rather than specific afferentation. References reviewed here are consistent in their descriptions of histology, particularly in studies of locales rich in cholinergic neurons. We discuss the therapeutic implications of a basal forebrain site that may activate cortex. Interventions that specifically target nucleus basalis and, especially, the survival of its constituent neurons may benefit afflictions in which higher cortical function is compromised due to disturbed arousal or attentiveness, including not only coma and related syndromes, but also conditions colloquially described as states of cognitive “fog” or of “long-haul” mental compromise.
Background:
There is concern that immune checkpoint inhibitors (ICPIs) can provoke relapses in people with multiple sclerosis (pwMS).
Objective:
Analyze outcomes of pwMS who received ICPI treatment ...for malignancy.
Methods:
We electronically identified pwMS who received ICPI treatment at Mass General Brigham hospital system. We retrospectively obtained information about patients’ MS, cancer, treatment, and outcomes.
Results:
Sixteen patients were identified with an average (standard deviation (SD)) age of 67.4 (11.9) years. Eleven (68.8%) had no relapses since MS diagnosis. None had MS relapses after ICPI treatment or new MS lesions.
Conclusion:
ICPI use was not associated with increased clinical disease activity in this cohort of older patients with inactive MS.
Spinal Cord Disorders: Myelopathy Bhattacharyya, Shamik
The American journal of medicine,
November 2018, 2018-11-00, 20181101, Letnik:
131, Številka:
11
Journal Article
Recenzirano
Myelopathy is a clinical diagnosis based on symptoms and physical examination findings. Laboratories and imaging, particularly with magnetic resonance imaging, can suggest a cause. Compressive ...myelopathy from degenerative disease of the vertebral column is the most common cause of myelopathy in older adults and should be screened for first in most cases. There are many other causes of myelopathy, including infectious, immune-mediated, nutritional, vascular, and neoplastic etiologies.
The phenomenon of clasmatodendrosis Balaban, Denis; Miyawaki, Edison K.; Bhattacharyya, Shamik ...
Heliyon,
07/2021, Letnik:
7, Številka:
7
Journal Article
Recenzirano
Odprti dostop
Clasmatodendrosis derives from the Greek for fragment (klasma), tree (dendron), and condition (- osis). Cajal first used the term in 1913: he observed disintegration of the distal cell processes of ...astrocytes, along with a fragmentation or beading of proximal processes closer to the astrocyte cell body. In contemporary clinical and experimental reports, clasmatodendrosis has been observed in models of cerebral ischemia and seizures (including status epilepticus), in elderly brains, in white matter disease, in hippocampal models and cell cultures associated with amyloid plaques, in head trauma, toxic exposures, demyelinating diseases, encephalitides and infection-associated encephalopathies, and in the treatment of cancer using immune effector cells. We examine evidence to support a claim that clasmatodendrotic astrocyte cell processes overtly bead (truncate) as a morphological sign of ongoing damage premortem. In grey and white matter and often in relationship to vascular lumina, beading becomes apparent with immunohistochemical staining of glial fibrillary acidic protein when specimens are examined at reasonably high magnification, but demonstration of distal astrocytic loss of processes may require additional marker study and imaging. Proposed mechanisms for clasmatodendrotic change have examined hypoxic-ischemic, osmotic-demyelinating, and autophagic models. In these models as well as in neuropathological reports, parenchymal swelling, vessel-wall leakage, or disturbed clearance of toxins can occur in association with clasmatodendrosis. Clasmatodendrotic features may serve as a marker for gliovascular dysregulation either acutely or chronically. We review correlative evidence for blood-brain barrier (BBB) dysfunction associated with astrocytic structural change, with attention to interactions between endothelial cells, pericytes, and astrocytic endfeet.
Clasmatodendrosis, Astrocyte, Endfoot, Blood-brain barrier, Endothelial cell, Pericyte
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